Conventional versus stereotactic image guided pedicle screw placement during spinal deformity correction: a retrospective propensity score-matched study of a national longitudinal database
| Autor: | Allen L Ho, Arjun V Pendharkar, Eric S Sussman, Anand Veeravagu, John K. Ratliff, Paymon Rezaii, Atman Desai |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Reoperation 0301 basic medicine Adolescent medicine.medical_treatment Deformity correction Spinal deformity correction Osteotomy computer.software_genre Patient Readmission Spinal Curvatures Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Pedicle Screws Outcome Assessment Health Care Deformity Humans Medicine Orthopedic Procedures Pedicle screw fixation Child Pedicle screw Retrospective Studies Database business.industry General Neuroscience General Medicine Middle Aged Spinal Fusion 030104 developmental biology Surgery Computer-Assisted Child Preschool Propensity score matching Female Posterior instrumentation medicine.symptom business computer 030217 neurology & neurosurgery |
| Zdroj: | International Journal of Neuroscience. 131:953-961 |
| ISSN: | 1543-5245 0020-7454 |
| DOI: | 10.1080/00207454.2020.1763343 |
| Popis: | PURPOSE/AIM To compare complications, readmissions, revisions, and payments between navigated and conventional pedicle screw fixation for treatment of spine deformity. METHODS The Thomson Reuters MarketScan national longitudinal database was used to identify patients undergoing osteotomy, posterior instrumentation, and fusion for treatment of spinal deformity with or without image-guided navigation between 2007-2016. Conventional and navigated groups were propensity-matched (1:1) to normalize differences between demographics, comorbidities, and surgical characteristics. Clinical outcomes and charges were compared between matched groups using bivariate analyses. RESULTS A total of 4,604 patients were identified as having undergone deformity correction, of which 286 (6.2%) were navigated. Propensity-matching resulted in a total of 572 well-matched patients for subsequent analyses, of which half were navigated. Rate of mechanical instrumentation-related complications was found to be significantly lower for navigated procedures (p = 0.0371). Navigation was also associated with lower rates of 90-day unplanned readmissions (p = 0.0295), as well as 30- and 90-day postoperative revisions (30-day: p = 0.0304, 90-day: p = 0.0059). Hospital, physician, and total payments favored the conventional group for initial admission (p = 0.0481, 0.0001, 0.0019, respectively); however, when taking into account costs of readmissions, hospital payments became insignificantly different between the two groups. CONCLUSIONS Procedures involving image-guided navigation resulted in decreased instrumentation-related complications, unplanned readmissions, and postoperative revisions, highlighting its potential utility for the treatment of spine deformity. Future advances in navigation technologies and methodologies can continue to improve clinical outcomes, decrease costs, and facilitate widespread adoption of navigation for deformity correction. |
| Databáze: | OpenAIRE |
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