Economic study: a cost-effectiveness analysis of an intraoperative compared with a preoperative image-guided system in lumbar pedicle screw fixation in patients with degenerative spondylolisthesis

Spine J. 2014 Aug 1;14(8):1790-6. doi: 10.1016/j.spinee.2013.10.019. Epub 2013 Oct 31.


Background context: In spinal surgery, newly developed technology seems to play a key role, especially with the use of computer-assisted image-guided navigation, giving excellent results. However, these tools are expensive and may not be affordable for many facilities.

Purpose: To compare the cost-effectiveness of preoperative versus intraoperative CT (computed tomography) guidance in spinal surgery.

Study design: A retrospective economic study.

Methods: A cost-effectiveness study was performed analyzing the overall costs of a population of patients operated on for lumbar degenerative spondylolisthesis using an image-guided system (IGS) based on a CT scan. The population was divided into two groups according to the type of CT data set acquisition adopted: Group I (IGS based on a preoperative spiral CT scan), Group II (IGS based on an intraoperative CT scan-O-Arm system). The costs associated with each procedure were assessed through a process analysis, where clinical procedures were broken down into single phases and the related costs from each phase were evaluated. No benefits in any form have been or will be received from commercial parties directly or indirectly related to the subject of this article.

Results: Four hundred ninety-nine patients met the criteria for this study. In total, 2,542 screws were inserted with IGS. Baseline data were similar for the two groups, as were hospitalization and complications. The surgical time was 119±43 minutes in Group I and 92±31 minutes in Group II. The full cost of the two procedures was analyzed: the mean cost, using the O-Arm system (Group II), was found to be €255.83 (3.80%) less than the cost of Group I. Moreover, the O-Arm system was also used in other surgical procedures as an intraoperative control, thus reducing the final costs of radiologic examinations (a reduction of around 550 CT scans/year).

Conclusions: In conclusion, the authors of the study are of the opinion that the surgical procedure of pedicle screw fixation, using a CT-based computer-guidance system with support of the O-Arm system, allows a shortening of procedure time that might improve the clinical result. However, the present study failed to determine a clear cost-effectiveness with respect to other CT-based IGS.

Keywords: Costs; Economic analysis; Imaging; Navigation system; Spine.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Lumbar Vertebrae / surgery
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / economics*
  • Orthopedic Procedures / economics*
  • Orthopedic Procedures / methods
  • Pedicle Screws / economics*
  • Preoperative Care / economics*
  • Retrospective Studies
  • Spondylolisthesis / economics
  • Spondylolisthesis / surgery*
  • Surgery, Computer-Assisted / economics*
  • Surgery, Computer-Assisted / methods