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P41. The Societal Perspective on Postoperative Spine Surgery Infections and Cost Shifting
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S-205S intact model. IDP and motion after L4/5 laminotomy were very close to the intact model, especially in flexion. The distance of L4-L5 foramina in both surgical models decreased in extension, lateral bending and axial rotation compared with the intact model. However, there was no difference foraminal opening between laminectomy and laminotomy. Facet load at L4-L5 after both procedures decreased in extension, lateral bending, axial rotationl. CONCLUSIONS: The increase in IDP and motion for laminectomy case means that the load on the disc is higher as compared to the midline sparing. Further, it may lead to disc degeneration and decrease in disc height more than the midline sparing. Thus, our findings support our hypothesis that mid line sparing laminotomy prevents disc collapse due to reduced disc loading without sacrificing the opening of formina, as compared to the traditional laminectomy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.297
P40. Long-Term Results of Computer-Assisted Posterior Occipitocervical/Thoracic Reconstruction Nobuhide Ogihara, Jun Takahashi, MD, PhD, Hiroki Hirabayashi, MD, Hiroyuki Hashidate, MD, Hiroyuki Kato; Matsumoto-city, Nagano, Japan BACKGROUND CONTEXT: Instability of the occipitocervical junction can be a challenging surgical problem because of the unique anatomic and biomechanical characteristics of this region. Many methods of occipitocervical reconstruction have been reported, however; to our knowledge, there have been no reports of the long-term surgical results of occipitocervical/ thoracic reconstruction using computer-assisted pedicle screws insertion. PURPOSE: The purpose of this study was to evaluate the long-term surgical results and the usefulness of the computer-assisted occipitocervical/ thoracic reconstruction using the plate-rod/pedicle screw system. STUDY DESIGN/SETTING: This retrospective study was conducted to analyze the clinical results in 20 patients with lesions at the craniocervical junction that had been treated by occipitocervical/thoracic reconstruction using computer-assisted implantation of pedicle screws. PATIENT SAMPLE: Between January 1999 and July 2006, a total of 20 cases (male 9,female 11) disorders at the craniocervical junction required posterior occipitocervical/thotacic reconstruction. The mean age at the time of surgery was 58.4 years (range, 15-78 years). The mean followup was 48.3 months (range, 24-96 months). OUTCOME MEASURES: Roentgenological measurement of atrantodental interval, Ranawat value and clivoaxial angle were performed. Japanese Orthopedic Association scoring system and Ranawat classification, the neurological deficit were used in clinical evaluation from before surgery to final follow up. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of screw placement. METHODS: Patients had been treated by occipitocervical/thoracic reconstruction using plate-rod/pedicle screw system. A frameless stereotactic image-guidance system that is CT-based, and optoelectronic was used for inserting pedicle screw accurately. RESULTS: Mean atlantdental interval and Ranawat value were significantly improved (p!0.05), mean clivoaxial angle was increased after surgery and maintained at final follow-up, respectively. Mean Japanese Orthopedic Association score before and after surgery was 7.8964.4 points and 12.162.8 points, showing significant improvement (p50.001). Mean recovery rate was 35.4%. There were 15 cases (75%) improved more than one rank with Ranawat’s classification. On the other hand, five patients (25%) remained the same at the final follow-up. Solid union was achieved in all 20 patients. A total 80 pedicle screws were inserted into cervical and upper thoracic pedicle using CT-based navigation system and only one screw (1.3%) showed the major pedicle wall perforation. CONCLUSIONS: Occipitocervical/thoracic reconstruction by the combination of cervical pedicle screws and occipitocervical rod systems provided the high fusion rate and maintained the alignment in the occipitoatlantoaxial region without the need for halo vest immobilization.
135S
Computer-assisted image-guidance system was the useful tool as means to insert pedicle screw accurately and safely. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.298
P41. The Societal Perspective on Postoperative Spine Surgery Infections and Cost Shifting David Polly, Jr., MD1, Charles Ledonio, MD1, Christopher Shaffrey, MD2, Steven Glassman, MD3; 1University of Minnesota, Minneapolis, MN, USA; 2 University of Virginia, Charlottesville, VA, USA; 3University of Louisville, Louisville, KY, USA BACKGROUND CONTEXT: Infection after spinal surgery is a predictable event at some rate. Post-operative wound infections range from less than 1% after a simple discectomy to 6-8% after attempted fusion with instrumentation. In a recent meta-analysis, infection rates were 2.2% in patients treated with prophylactic antibiotics versus 5.9% without. Currently CMS is proposing making hospital acquired infection (HAI) a never event. This will result in significant shifting of the costs to the hospitals or other sources. PURPOSE: To estimate the magnitude of the cost burden that would be shifted if CMS makes HAI a never event. STUDY DESIGN/SETTING: Literature review and healthcare cost analysis PATIENT SAMPLE: Nationwide in-patient demographics OUTCOME MEASURES: Incidence and costs of postoperative spine infections. METHODS: Postoperative spine infection rates were identified by literature review. Spinal fusion surgery rates were identified via the HCUP data base. The cost for treatment of a spine infection was identified from the literature. The medical consumer price index was used to normalize to current costs. RESULTS: There are about 300,000 instrumented spinal fusions, with about a 2% infection rate resulting in 6,000 infections per year. The cost for treatment in 1996 was $100,000, the medical consumer price index increase from 1996 to 2008 was 59% giving a per case treatment of $159,000 x 6000 cases for an annual financial burden of $954,000,000. If these infections could be avoided by additional interventions at the time of surgery it would be cost neutral at a price point of $954,000,000/300,000 cases or $318 per case. These calculations are dependent upon each of the parameter estimates which may vary by a log order up or down. CONCLUSIONS: If HAI is declared a never event by CMS the unfunded cost burden that will have to be born by society approaches $1 Billion. This cost would ultimately be shifted to the insured, non-Medicare/Medicaid population. This money would probably be better spent on investments in avoiding infections and saving the patients this morbidity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.299
P42. Posterior Dynamic Stabilization of the Lumbar Spine with the Accuflex Rod System as a Stand-Alone Device. Experience in 20 Patients with Two Year Follow-Up Alejandro Reyes Sanchez1, Baro´n Za´rate-Kalfo´pulos, MD2, Luis Miguel Rosales-Olivarez3, Isabel Ramirez-Mora3, Armando AlpizarAguirre4, Guadalupe Sa´Nchez-Bringas4; 1Centro Nacional de Rehabilitacion, Mexico City, Distrito Federal, Mexico; 2Mexico Distrito Federal, Mexico; 3Instituto Nacional de Rehabilitacio´n, Mexico Distrito Federal, Mexico Distrito Federal, Mexico; 4Instituto Nacional de Rehabilitacio´n, Me´xico Distrito Federal, Me´xico Distrito Federal, Mexico BACKGROUND CONTEXT: Fusion is a widespread and accepted treatment for painful degenerative conditions of the lumbar spine. Nevertheless
P40. Long-Term Results of Computer-Assisted Posterior Occipitocervical/Thoracic Reconstruction Nobuhide Ogihara, Jun Takahashi, MD, PhD, Hiroki Hirabayashi, MD, Hiroyuki Hashidate, MD, Hiroyuki Kato; Matsumoto-city, Nagano, Japan BACKGROUND CONTEXT: Instability of the occipitocervical junction can be a challenging surgical problem because of the unique anatomic and biomechanical characteristics of this region. Many methods of occipitocervical reconstruction have been reported, however; to our knowledge, there have been no reports of the long-term surgical results of occipitocervical/ thoracic reconstruction using computer-assisted pedicle screws insertion. PURPOSE: The purpose of this study was to evaluate the long-term surgical results and the usefulness of the computer-assisted occipitocervical/ thoracic reconstruction using the plate-rod/pedicle screw system. STUDY DESIGN/SETTING: This retrospective study was conducted to analyze the clinical results in 20 patients with lesions at the craniocervical junction that had been treated by occipitocervical/thoracic reconstruction using computer-assisted implantation of pedicle screws. PATIENT SAMPLE: Between January 1999 and July 2006, a total of 20 cases (male 9,female 11) disorders at the craniocervical junction required posterior occipitocervical/thotacic reconstruction. The mean age at the time of surgery was 58.4 years (range, 15-78 years). The mean followup was 48.3 months (range, 24-96 months). OUTCOME MEASURES: Roentgenological measurement of atrantodental interval, Ranawat value and clivoaxial angle were performed. Japanese Orthopedic Association scoring system and Ranawat classification, the neurological deficit were used in clinical evaluation from before surgery to final follow up. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of screw placement. METHODS: Patients had been treated by occipitocervical/thoracic reconstruction using plate-rod/pedicle screw system. A frameless stereotactic image-guidance system that is CT-based, and optoelectronic was used for inserting pedicle screw accurately. RESULTS: Mean atlantdental interval and Ranawat value were significantly improved (p!0.05), mean clivoaxial angle was increased after surgery and maintained at final follow-up, respectively. Mean Japanese Orthopedic Association score before and after surgery was 7.8964.4 points and 12.162.8 points, showing significant improvement (p50.001). Mean recovery rate was 35.4%. There were 15 cases (75%) improved more than one rank with Ranawat’s classification. On the other hand, five patients (25%) remained the same at the final follow-up. Solid union was achieved in all 20 patients. A total 80 pedicle screws were inserted into cervical and upper thoracic pedicle using CT-based navigation system and only one screw (1.3%) showed the major pedicle wall perforation. CONCLUSIONS: Occipitocervical/thoracic reconstruction by the combination of cervical pedicle screws and occipitocervical rod systems provided the high fusion rate and maintained the alignment in the occipitoatlantoaxial region without the need for halo vest immobilization.
135S
Computer-assisted image-guidance system was the useful tool as means to insert pedicle screw accurately and safely. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.298
P41. The Societal Perspective on Postoperative Spine Surgery Infections and Cost Shifting David Polly, Jr., MD1, Charles Ledonio, MD1, Christopher Shaffrey, MD2, Steven Glassman, MD3; 1University of Minnesota, Minneapolis, MN, USA; 2 University of Virginia, Charlottesville, VA, USA; 3University of Louisville, Louisville, KY, USA BACKGROUND CONTEXT: Infection after spinal surgery is a predictable event at some rate. Post-operative wound infections range from less than 1% after a simple discectomy to 6-8% after attempted fusion with instrumentation. In a recent meta-analysis, infection rates were 2.2% in patients treated with prophylactic antibiotics versus 5.9% without. Currently CMS is proposing making hospital acquired infection (HAI) a never event. This will result in significant shifting of the costs to the hospitals or other sources. PURPOSE: To estimate the magnitude of the cost burden that would be shifted if CMS makes HAI a never event. STUDY DESIGN/SETTING: Literature review and healthcare cost analysis PATIENT SAMPLE: Nationwide in-patient demographics OUTCOME MEASURES: Incidence and costs of postoperative spine infections. METHODS: Postoperative spine infection rates were identified by literature review. Spinal fusion surgery rates were identified via the HCUP data base. The cost for treatment of a spine infection was identified from the literature. The medical consumer price index was used to normalize to current costs. RESULTS: There are about 300,000 instrumented spinal fusions, with about a 2% infection rate resulting in 6,000 infections per year. The cost for treatment in 1996 was $100,000, the medical consumer price index increase from 1996 to 2008 was 59% giving a per case treatment of $159,000 x 6000 cases for an annual financial burden of $954,000,000. If these infections could be avoided by additional interventions at the time of surgery it would be cost neutral at a price point of $954,000,000/300,000 cases or $318 per case. These calculations are dependent upon each of the parameter estimates which may vary by a log order up or down. CONCLUSIONS: If HAI is declared a never event by CMS the unfunded cost burden that will have to be born by society approaches $1 Billion. This cost would ultimately be shifted to the insured, non-Medicare/Medicaid population. This money would probably be better spent on investments in avoiding infections and saving the patients this morbidity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.299
P42. Posterior Dynamic Stabilization of the Lumbar Spine with the Accuflex Rod System as a Stand-Alone Device. Experience in 20 Patients with Two Year Follow-Up Alejandro Reyes Sanchez1, Baro´n Za´rate-Kalfo´pulos, MD2, Luis Miguel Rosales-Olivarez3, Isabel Ramirez-Mora3, Armando AlpizarAguirre4, Guadalupe Sa´Nchez-Bringas4; 1Centro Nacional de Rehabilitacion, Mexico City, Distrito Federal, Mexico; 2Mexico Distrito Federal, Mexico; 3Instituto Nacional de Rehabilitacio´n, Mexico Distrito Federal, Mexico Distrito Federal, Mexico; 4Instituto Nacional de Rehabilitacio´n, Me´xico Distrito Federal, Me´xico Distrito Federal, Mexico BACKGROUND CONTEXT: Fusion is a widespread and accepted treatment for painful degenerative conditions of the lumbar spine. Nevertheless