Cost-effectiveness of image-guided spine surgery

Objective: To determine if image-guided spine surgery is cost effective.

Methods: A prospective case series of the first 100 patients undergoing thoracolumbar pedicle screw instrumentation under image-guidance was compared to a retrospective control group of the last 100 patients who underwent screw placement prior to the use of image-guidance. The image-guidance system was NaviVision (Vector Vision-BrainLAB) and Arcadis Orbic (Siemens).

Results: The rate of revision surgery was reduced from 3% to 0% with the use of image guidance (p=0.08). The cost savings of image guidance for the placement of pedicle screws was $71,286 per 100 cases. Time required for pedicle screw placement with image guidance was 20 minutes for 2 screws, 29 minutes for 4 screws, 38 minutes for 6 screws, and 50 min for 8 screws. Cost savings for the time required for placement of pedicle screws with image guidance can be estimated by subtracting the time required with currently used techniques without image guidance from the above averages, then multiplying by $93 per minute. The approximate costs of the navigation system is $475,000 ( $225,000 for Vector Vision-BrainLAB and $250,000 for Arcadis Orbic-Siemens).

Conclusion: Image guidance for the placement of pedicle screws may be cost effective in spine practices with heavy volume, that perform surgery in difficult cases, and that require long surgical times for the placement of pedicle screws.