RESUMEN
BACKGROUND CONTEXT: Limited data are available regarding incidence of proximal junctional acute collapse after multilevel lumbar spine fusion. There are no data regarding the cost of prophylactic vertebral augmentation adjacent to long lumbar fusions compared with the costs of performing revision fusion surgery for patients suffering with this complication. PURPOSE: To perform a cost analysis of prophylactic vertebral augmentation for prevention of proximal junctional acute collapse after multilevel lumbar fusion. STUDY DESIGN: Retrospective chart review and cost analysis. PATIENT SAMPLE: All female patients older than 60 years undergoing extended lumbar fusions were reviewed to establish the incidence of proximal junctional acute collapse. OUTCOME MEASURES: Cost estimates for two-level vertebroplasty, two-level kyphoplasty, and revision instrumented fusion were calculated using billing data and cost-to-charge ratios. METHODS: Cost comparisons of prophylactic vertebral augmentation versus extension of fusion for patients suffering from proximal junctional acute collapse were performed. RESULTS: Twenty-eight female patients older than 60 years underwent lumbar fusions from L5 or S1 extending to the thoracolumbar junction (T9-L2). Fifteen of the 28 patients had prophylactic vertebroplasty cranial to the fused segment. Proximal junctional acute collapse requiring revision surgery occurred in 2 of the 13 patients (15.3%) treated without prophylactic vertebroplasty. None of the 15 patients undergoing cement augmentation experienced this complication. Assuming a 15% decrease in the incidence of proximal junctional acute collapse, the estimated cost to prevent a single proximal junctional acute collapse was $46,240 using vertebroplasty and $82,172 using kyphoplasty. Inpatient costs associated with a revision instrumented fusion averaged $77,432. CONCLUSIONS: Prophylactic vertebral augmentation for the prevention of proximal junctional acute collapse may be a cost effective intervention in elderly female patients undergoing extended lumbar fusions. Further efforts are needed to determine more precisely the incidence of proximal junctional acute collapse and the effects of various risk factors on increasing this incidence, as well as methods of prevention.
Asunto(s)
Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/economía , Enfermedades de la Columna Vertebral/economía , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/economía , Vertebroplastia/economía , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Comorbilidad , Costos y Análisis de Costo , Femenino , Fracturas por Compresión/economía , Fracturas por Compresión/epidemiología , Fracturas por Compresión/prevención & control , Fracturas por Compresión/cirugía , Costos de la Atención en Salud , Humanos , Incidencia , Inestabilidad de la Articulación/economía , Inestabilidad de la Articulación/epidemiología , Inestabilidad de la Articulación/cirugía , Persona de Mediana Edad , Osteoporosis/economía , Osteoporosis/epidemiología , Osteoporosis/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Reoperación/economía , Estudios Retrospectivos , Sacro/cirugía , Escoliosis/economía , Escoliosis/epidemiología , Escoliosis/cirugía , Enfermedades de la Columna Vertebral/epidemiología , Fusión Vertebral/efectos adversos , Fusión Vertebral/estadística & datos numéricos , Vertebroplastia/estadística & datos numéricosRESUMEN
Elderly patients with lumbar spine degenerative disease present significant challenges regarding surgical decision making and management. Because osteoporosis is a particularly prevalent comorbidity in the elderly population, it must be a concern in all elderly patients with degenerative disease of the lumbar spine. Careful attention to surgical indications and surgical technique is always required for the successful treatment of this challenging patient population.
