Here are 10 recent studies to know on the effectiveness and cost of spine surgery.
Reoperation rates for fusion and arthroplasty. A study recently published in Spine found that reoperation rate is significantly less among patients undergoing total disc replacement than anterior cervical fusion. Reoperation rate for TDR was 8.3 percent, compared with ACF, which was 21.2 percent. Reoperation for adjacent segment degeneration in TDR was significantly less than ACF, at 4.8 percent compared to 13.5 percent. Patients in the TDR group had significantly longer survival period before undergoing reoperation under the Kaplan-Meier survival analysis.
ACDF for cervical radiculopathy. A study published in Spine recently compared the outcome of anterior cervical decompression and fusion combined with a structured physiotherapy program to the same program without surgery for patients with cervical radiculopathy. Around 87 percent of the patients in the surgical group rated symptoms as much better during the 12 month follow-up, compared with 62 percent of the non-surgical group. No significant difference was reported in neck disability index or pain intensity.
TLIF in outpatient centers. A study published in the Journal of Spinal Disorders and Techniques examined the feasibility of outpatient instrumented transforaminal lumbar interbody fusion. Surgeries were performed either in the ambulatory surgery center setting or hospital outpatient department and researchers recorded complications that occurred from the moment of discharge up to six months postoperatively. Researchers found no cases of pneumonia, urinary tract infection or thromboembolic complications. Four of the 27 patients who underwent the procedure at ASCs had complications within seven days postoperatively compared with one of the 25 patients who underwent the procedure in the hospital outpatient department. The difference was not statistically significant.
BMP for achieving fusion. The newest issue of the Annals of Internal Medicine contains two studies evaluating the safety and effectiveness of Medtronic's recombinant human bone morphogenic protein, Infuse, in spinal fusion surgery. The studies meta-analyzed data from spinal fusion surgeries that used iiliac crest bone grafts as well as data from Medtronic on patients treated with Infuse. While the Medtronic product appeared similarly effective to iliac crest bone grafts, both pain and cancer were more commonly reported after the use of Infuse. Both studies concluded that while Infuse is comparably effective to an iliac crest bone graft, it is correlated with adverse outcomes such as little pain reduction and cancer at higher rates post-surgery.
Cost of BMP-related complications. A retrospective review of patients who underwent minimally invasive transforaminal lumbar interbody fusion from 2007 to 2010 that included rhBMP-2 found that complications resulted in substantial financial cost for the patients and surgeon, according to a report published in The Spine Journal. The review included 573 patients who underwent an MIS laminectomy with bilateral facetectomy, single TLIF cage, unilateral pedicel screw fixation and 12 mg or 4.2 mg of rhBMP-2 by a single surgeon. There were 39 patients underwent re-operation for clinically symptomatic pseudarthrosis and bone overgrowth associated with nerve impingement and radiculopathy was found in 10 patients. The average total cost per procedure was $19, 224 and costs for re-operation equaled $14,785 per encounter for neuroforaminal bone growth and $20,267 for pseudarthrosis.
High-dose BMP. A study published in the Journal of Bone and Joint Surgery examined the impact of high-dose rhBMP-2. The study authors examined 502 consecutive adult patients who received a high dosage, on average 115 mg, of rhBMP-2, for complex spinal procedures. There were 265 primary and 237 revision procedures with 261 patients receiving an interbody device. There was an average of 11.5 vertebrae instrumented. The interoperative complication rate was 8.2 percent and cancer prevalence was 2.6 percent, but there was no correlation between increasing rhBMP-2 dosage and cancer, radiculopathy or seroma.
Pediatric BMP use. From 2003 to 2009, recombinant human bone morphogenic protein use in pediatric spinal fusion increased from use in 2.7 percent of cases to 9.3 percent of cases, with an average increase of 16 percent per year, according to a new study published in the Journal of Bone and Joint Surgery. Data on the 3.4-fold increase in BMP use came from the Nationwide Inpatient Sample database where 4,817 children were identified who underwent spinal fusion surgery during that period. BMP was used less in teaching hospitals and more in hospitals with large bed capacity.
Adult spinal deformity readmission risks. A recent study published in Spine examined the hospital readmission risks for patients with adult spinal deformity. The study gathered information from a single institution from 2006 to 2011 for 836 patients who received spinal fusion for adult deformity. The unplanned readmission rate was 8.4 percent within 30 days and 12.3 percent at 90 days. They found longer fusion length, high patient severity of illness and specific medical comorbidities as risk factors. Around 45.6 percent of readmissions were attributable to surgical site infection.
Infection risk from spine surgery. A study in the July 1 issue of Spine finds that preoperative delays in excess of one hour significantly increase the risk of surgical site infections. Researchers found that the group of patients with confirmed surgical site infections had a significantly greater mean preoperative time than did the group without SSIs. Additionally, the risk of an SSI was 4.9 percent with greater than one hour of preoperative time, compared to 2.3 percent with less than one hour of preoperative time.
Spine implant costs. At the 2013 AAOS Annual Meeting, researchers presented the results of a study of 45 academic medical centers' spinal implant purchasing records. "Everyone is looking at implants because everyone is feeling the costs," says Samuel Bederman, MD, an assistant clinical professor of orthopedic surgery at the University of California Irvine Health and co-author of the study. "Providers try to align themselves with surgeons to reduce costs, but oftentimes as surgeons we decide what works best and the cost information isn't provided to us." The study found a noteworthy correlation between lower implant costs and higher volume purchases. However, insurance companies scrutinize spine surgical authorizations more today than in the past, and this could lead to lower volumes of surgical procedures. Dr. Bederman advocates for more transparency from insurance companies about implant prices across different providers to sustain surgical services.
"Overall prices have remained high and the hospital and physicians are being squeezed," says Dr. Bederman. "The sustainability of current costs are challenging. I think we all need to understand that prices are very high and unsustainable, and transparency would be one way we can factor costs somewhere into the equation of what gets selected and paid for by hospitals."
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