Cost-utility Analysis of Anterior Cervical Discectomy and Fusion for Cervical Spondylosis Patients Comparing Polyetheretherketone Versus Tricortical Iliac Crest Bone Graft.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To perform a cost-utility analysis and to investigate the clinical outcomes and patient's quality of life after anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis compared between fusion with polyetheretherketone (PEEK) and fusion with tricortical iliac bone graft (IBG) in Thailand. SUMMARY OF BACKGROUND DATA: ACDF is one of the standard treatments for cervical spondylosis. The fusion material options include PEEK and tricortical IBG. No previous studies have compared the cost-utility between these 2 fusion material options. PATIENTS AND METHODS: Patients with cervical spondylosis who were scheduled for ACDF at Siriraj Hospital (Bangkok, Thailand) during 2019-2020 were prospectively enrolled. Patients were allocated to the PEEK or IBG fusion material group according to the patient's choice of fusion material. EuroQol-5 dimensions 5 levels and relevant costs were collected during the operative and postoperative periods. A cost-utility analysis was performed using a societal perspective. All costs were converted to 2020 United States dollars (USD), and a 3% discount rate was used. The outcome was expressed as the incremental cost-effectiveness ratio. RESULTS: Thirty-six patients (18 ACDF-PEEK and 18 ACDF-IBG) were enrolled. Except for Nurick grading, there was no significant difference in patient baseline characteristics between groups. The average utility at 1 year after ACDF-PEEK and ACDF-IBG were 0.939 ± 0.061 and 0.798 ± 0.081, respectively ( P < 0.001). The total lifetime cost of ACDF-PEEK and ACDF-IBG was 83,572 USD and 73,329 USD, respectively. The incremental cost-effectiveness ratio of ACDF-PEEK when compared with that of ACDF-IBG showed a gain of 4468.52 USD/quality-adjusted life-years, which is considered cost-effective at the Thailand willingness-to-pay threshold of 5115 USD/quality-adjusted life-year gained. CONCLUSIONS: ACDF-PEEK was found to be more cost-effective than ACDF-IBG for treating cervical spondylosis in Thailand. LEVEL OF EVIDENCE: Level II.

Management of Traumatic Spinal Fracture in the Coronavirus Disease 2019 Situation.

The coronavirus outbreak was labeled a pandemic by the World Health Organization in 2020. Patients who require spine surgery should receive coronavirus disease 2019 (COVID-19) screening to prevent nosocomial cross-infection before surgery. However, spine fracture and spinal injury are critical and serious, and there are no standard protocols for management. This article aims to propose a treatment algorithm for the management of traumatic spine fracture during the COVID-19 pandemic.

Bilateral pure facet joint dislocation in thoracolumbar junction (T11-T12) without facet fracture using a 3D digital printing model for surgical planning: A case report.

BACKGROUND: Thoracolumbar junction pure bilateral facet joint dislocation without facet fracture is an extremely rare injury. A current review of thoracolumbar junction pure bilateral facet joint dislocation reported less than 15 cases in which the surgeon had a difficulty with the dissection of surgical planning using only 2D radiographic film and the axial or coronal view in computerized tomography. Bilateral pure facet joint dislocation in the thoracolumbar junction without facet fracture is difficult to understand the morphology of bone injuries. CASE PRESENTATION: A 25-year-old Thai gentleman presented with paraplegia and loss of sensation in the lower extremity (ASIA A) following a fall from a high lorry. Radiographic film and computed tomography scan revealed pure facet dislocation T11-T12 without facet fracture. The patient's thoracolumbar junction of the spine is presented to describe the three-dimensional (3D) printing technique for surgical preoperative planning. After the patient underwent open reduction, decompression and instrumentation with posterolateral fusion, the patient's thoracolumbar junction was described in the three-dimensional (3D) printing again for follow-up and in order to help the surgeon understand about the morphology and alignment after surgery. CONCLUSION: Pure facet dislocation is rarely seen at the thoracolumbar junction; it is a very unstable injury. In this case, we performed an early investigation using a 3D digital printing model in order to help with orthopedic surgical planning, emergency early open reduction and instrumentation with fusion. Neurological status was recovered. The 3D digital printing model should be a standard investigation in rare cases of orthopedic surgical planning.