Skip to main content

Advertisement

SpringerLink
Log in

Financial analysis of circumferential fusion versus posterior-only with thoracic pedicle screw constructs for main thoracic idiopathic curves between 70° and 100°

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Reports on thoracic pedicle screw (TPS) constructs have demonstrated their safety and efficacy; however, concerns exist regarding their increased cost. This is a review of adolescents with main thoracic scoliosis surgically treated with anterior release and posterior fusion or posterior fusion only. The objectives were to compare the radiographic outcomes and financial data of two surgical treatments: anterior/posterior spinal fusion (APSF) versus posterior spinal fusion (PSF-TPS) alone with TPSs, in patients with large 70–100° main thoracic adolescent idiopathic scoliosis (AIS) curves.

Methods

We identified 43 patients with main thoracic Lenke type 1–4 AIS curves between 70 and 100° who had been treated with either APSF or PSF-TPS.

Results

Both groups had equivalent radiographic corrections postoperatively. The PSF-TPS group patients had higher implant charges, but the APSF group had higher surgeon procedural charges, operating room charges, anesthesia charges, and inpatient room charges. Total charges were $75,295 for the APSF group and $71,236 for the PSF-TPS group (P > 0.05). Analyses of two subgroups of the APSF group, anterior release via thoracotomy versus VATS and same-day versus staged surgeries, failed to change any of the above findings.

Conclusion

Based on this financial analysis, there was no statistically significant differences between the APSF and PSF-TPS groups, with equivalent radiographic corrections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kim YJ, Lenke LG, Bridwell KH et al (2005) Pulmonary function in adolescent idiopathic scoliosis relative to surgical approach. J Bone Joint Surg Am 87:1534–1541

    Article  PubMed  Google Scholar 

  2. Kim YJ, Lenke LG, Bridwell KH (2003) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis: a matched cohort analysis. Presented at Scoliosis Research Society Annual Meeting, Quebec City, Canada

    Google Scholar 

  3. Lenke LG, Padberg AM, Russo MH et al (1995) Triggered electromyographic threshold for accuracy of pedicle screw placement. An animal model and clinical correlation. Spine 20:1585–1591

    Article  PubMed  CAS  Google Scholar 

  4. Newton PO, Marks M, Faro F et al (2003) Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine 28(20S):S249–S254

    Article  PubMed  Google Scholar 

  5. Vendantam R, Lenke LG, Bridwell KH et al (2000) A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine 25(1):82–90

    Article  Google Scholar 

  6. Coe JD, Arlet V, Donaldson W et al (2004) Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the scoliosis research society mortality and morbidity committee. Presented at Scoliosis Research Society Annual Meeting, Buenos Aires, Argentina

    Google Scholar 

  7. Suk SI, Lee CK, Kim WJ et al (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405

    PubMed  CAS  Google Scholar 

  8. Brown CA, Lenke LG, Bridwell KH et al (1998) Complications of pediatric thoracolumbar and lumbar pedicle screws. Spine 23(14):1566–1571

    Article  PubMed  CAS  Google Scholar 

  9. Liljenqvist U, Lepsien U, Hackenberg L et al (2002) Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Eur Spine J 11:336–343

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. Lenke LG, Richards S, Stanitski CL (2004) Debate: resolved, a 55 degree right thoracic adolescent idiopathic scoliotic curve should be treated by posterior spinal fusion and segmental instrumentation using thoracic pedicle screws. J Pediatr Orthop 24:329–341

    Article  PubMed  Google Scholar 

  11. Suk SI, Lee CK, Min HJ et al (1994) Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis. Int Orthop 18:341–346

    Article  PubMed  CAS  Google Scholar 

  12. Lenke LG, Betz RR, Haher TR et al (2001) Multisurgeon assessment of surgical decision-making in adolescent idiopathic scoliosis: curve classification, operative approach, and fusion levels. Spine 26(21):2347–2353

    Article  PubMed  CAS  Google Scholar 

  13. Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83(8):1169–1181

    PubMed  Google Scholar 

  14. Kim YJ, Lenke LG, Bridwell KH et al (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29(3):333–342

    Article  PubMed  Google Scholar 

  15. Lenke LG (2003) Thoracic pedicle screw placement. Advances in spinal stabilization. In: Hiad R, Subach B, Rodts G (eds) New techniques in spine surgery, vol 16. Lunsford LD (series editor). Basel: S. Karger

  16. Lenke LG Rinella AS, Kim YJ (2002) Free-hand thoracic pedicle screw placement. Semin Spine Surg 14:48–57

    Google Scholar 

  17. Lenke LG, Kim YJ, Rinella AS (2002) Treatment of spinal deformity utilizing thoracic pedicle screws. Semin Spine Surg 14:66–87

    Google Scholar 

  18. Lehman RA Jr, Kuklo TR (2003) Use of anatomic trajectory for thoracic pedicle screw salvage after failure/violation using the straight-forward technique: a biomechanical analysis. Spine 28(18):2072–2077

    Article  PubMed  Google Scholar 

  19. Lehman RA Jr, Polly DW, Kuklo TR et al (2003) Straight-forward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis. Spine 28(18):2058–2065

    Article  PubMed  Google Scholar 

  20. Kuklo TR, Lehman RA Jr (2003) Effects of various tapping diameters on insertion of thoracic pedicle screws: a biomechanical analysis. Spine 28:2066–2077

    Article  PubMed  Google Scholar 

  21. Lenke LG, Betz RR, Clements D et al (2002) Curve prevalence of a new classification of operative adolescent idiopathic scoliosis: does classification correlate with treatment? Spine 27(6):604–611

    Article  PubMed  Google Scholar 

  22. Corporation CS (2001) StatXact 5. Statistical software for exact nonparametric inference. User manual volume 1. Cytel Software Corporation, Cambridge

    Google Scholar 

  23. Helenius I, Remes V, Yrjonen T et al (2003) Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis. Long-term functional and radiographic outcomes. J Bone Joint Surg Am 85:2303–2309

    PubMed  Google Scholar 

  24. Bridwell KH, Hanson DS, Rhee JM et al (2002) Correction of thoracic adolescent idiopathic scoliosis with segmental hooks, rods, and Wisconsin wires posteriorly: it’s bad and obsolete, correct? Spine 27(18):2059–2066

    Article  PubMed  Google Scholar 

  25. de Jonge T, Dubousset JF, Illes T (2002) Sagittal plane correction in idiopathic scoliosis. Spine 27(7):754–760

    Article  PubMed  Google Scholar 

  26. Lenke LG, Bridwell KH, Baldus C et al (1992) Cotrel-Dubousset instrumentation for adolescent idiopathic scoliosis. J Bone Joint Surg Am 74:1056–1067

    PubMed  CAS  Google Scholar 

  27. Engsberg JR, Lenke LG, Uhrich ML et al (2003) Prospective comparison of gait and trunk range of motion in adolescents with idiopathic thoracic scoliosis undergoing anterior or posterior spinal fusion. Spine 28(17):1993–2000

    Article  PubMed  Google Scholar 

  28. Lenke LG, Bridwell KH, Blanke KM et al (1998) Radiographic results of arthrodesis with Cotrel-Dubousset instrumentation for the treatment of adolescent idiopathic scoliosis. A five to ten-year follow-up study. J Bone Joint Surg Am 80:807–814

    PubMed  CAS  Google Scholar 

  29. Barr SJ, Schuette AM, Emans JB (1997) Lumbar pedicle screws versus hooks: results in double major curves in adolescent idiopathic scoliosis. Spine 22(12):1369–1379

    Article  PubMed  CAS  Google Scholar 

  30. Arlet V (2000) Anterior thoracoscopic spine release in deformity surgery: a meta-analysis and review. Eur Spine J 9:S17–S23

    Article  PubMed  Google Scholar 

  31. Lenke LG (2003) Anterior endoscopic discectomy and fusion for adolescent idiopathic scoliosis. Spine 28(15S):S36–S43

    Article  PubMed  Google Scholar 

  32. Niemeyer T, Freeman BJ, Grevitt MP et al (2000) Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity. Eur Spine J 9:499–504

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. Waisman M, Saute M (1997) Thoracoscopic spine release before posterior instrumentation in scoliosis. Clin Orthop 336:130–136

    Article  PubMed  Google Scholar 

  34. Newton PO, Shea KG, Granlund KF (2000) Defining the pediatric spinal thoracoscopy learning curve: Sixty-five consecutive cases. Spine 25(8):1028–1035

    Article  PubMed  CAS  Google Scholar 

  35. Graham EJ, Lenke LG, Lowe et al (2000) Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine 25(19):2319–2325

    Article  PubMed  CAS  Google Scholar 

  36. McDonnell MF, Glassman SD, Dimar JR et al (1996) Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am 78:839–847

    PubMed  CAS  Google Scholar 

  37. Roush TF, Crawford AH, Berlin RE et al (2001) Tension pneumothorax as a complication of video-assisted thorascopic surgery for anterior correction of idiopathic scoliosis in an adolescent female. Spine 26(4):448–450

    Article  PubMed  CAS  Google Scholar 

  38. Lenke LG, Bridwell KH, Blanke KM et al (1995) Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. Spine 20:1343–1350

    PubMed  CAS  Google Scholar 

  39. Wimmer C, Gluch H, Nogler M et al (2001) Treatment of idiopathic scoliosis with CD-instrumentation: lumbar pedicle screws versus laminar hooks in 66 patients. Acta Orthop Scand 72:615–620

    Article  PubMed  CAS  Google Scholar 

  40. Liljenqvist U, Allkemper T, Hackenberg L et al (2001) Analysis of the vertebral morphology in idiopathic scoliosis with magnetic resonance imaging using multiplanar reconstruction. Presented at Scoliosis Research Society Annual Meeting, Cleveland, Ohio

    Google Scholar 

  41. Liljenqvist UR, Link TM, Halm HF (2000) Morphometric analysis of the thoracic and lumbar vertebrae in idiopathic scoliosis. Spine 25(10):1247–1253

    Article  PubMed  CAS  Google Scholar 

  42. O’Brien MF, Lenke LG, Mardjetko S et al (2000) Pedicle morphology in the thoracic adolescent idiopathic scoliosis: is pedicle fixation an anatomically viable technique. Spine 25(18):2285–2293

    Article  PubMed  Google Scholar 

  43. Amoit LP, Lange K, Putzier M et al (2000) Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine 25(5):606–614

    Article  Google Scholar 

  44. Assaker R, Reyns N, Vinchon M et al (2001) Transpedicular screw placement: image-guided versus lateral-view fluoroscopy: in-vitro simulation. Spine 26(19):2160–2164

    Article  PubMed  CAS  Google Scholar 

  45. Laine T, Lund T, Ylikoski M et al (2000) Accuracy of pedicle screw insertion with and without computer assistance: a randomized controlled clinical study in 100 consecutive patients. Eur Spine J 9:235–241

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  46. Rampersaud YR, Simon DA, Foley KT (2001) Accuracy requirements for image-guided spinal pedicle screw placement. Spine 26(4):352–359

    Article  PubMed  CAS  Google Scholar 

  47. Schwarzenbach O, Berlemann U, Jost B et al (1997) Accuracy of computer-assisted pedicle screw placement: an in vivo computed tomography analysis. Spine 22(4):452–458

    Article  PubMed  CAS  Google Scholar 

  48. Xu R, Ebraheim NA, Shepherd ME et al (1999) Thoracic pedicle screw placement guided by computed tomographic measurements. J Spinal Disord 12:222–226

    PubMed  CAS  Google Scholar 

  49. Kuklo TR, Lenke LG, O’Brien MF, Lehman RA, Polly DW, Schroeder TM (2005) Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees. Spine 30:222–226

    Article  PubMed  Google Scholar 

  50. Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22(19):2239–2245

    Article  PubMed  CAS  Google Scholar 

  51. Suk SI, Kim WJ, Lee SM et al (2001) Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine 26(18):2049–2057

    Article  PubMed  CAS  Google Scholar 

  52. Papin P, Arlet V, Marchesi D et al (1999) Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J 8:156–159

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  53. Reidy DP, Houlden D, Nolan PC et al (2001) Evaluation of electromyographic monitoring during insertion of thoracic pedicle screws. J Bone Joint Surg Br 83:1009–1014

    Article  PubMed  CAS  Google Scholar 

  54. Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M (2005) Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary? Spine 30:2061–2067

    Article  PubMed  Google Scholar 

  55. Kuklo TR, Lenke LG, Potter BK, Polly DW, Sides B, Bridwell KH (2005) Surgical revision rate of hooks versus hybrid versus pedicle screw constructs for AIS. Paper #40. International meeting of advanced spinal techniques. Banff, Canada

    Google Scholar 

  56. Newton PO, Wenger DR, Mubarak SJ, Meyer RS (1997) Anterior release and fusion in pediatric spinal deformity. Spine 12:1398–1406

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shriner’s Hospital for Children, St. Louis Children’s Hospital, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO, 63110, USA

    Scott J. Luhmann, Lawrence G. Lenke & Keith H. Bridwell

  2. Hospital for Special Surgery, Weill Medical School, 525 East 70th Street, New York, NY, 10021, USA

    Yongjung J. Kim

  3. Division of Health Behavior Research, Washington University School of Medicine, 4444 Forest Park Ave., Ste 4700, St. Louis, MO, 63108, USA

    Mario Schootman

Authors
  1. Scott J. Luhmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lawrence G. Lenke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongjung J. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keith H. Bridwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Schootman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott J. Luhmann.

About this article

Cite this article

Luhmann, S.J., Lenke, L.G., Kim, Y.J. et al. Financial analysis of circumferential fusion versus posterior-only with thoracic pedicle screw constructs for main thoracic idiopathic curves between 70° and 100°. J Child Orthop 2, 105–112 (2008). https://doi.org/10.1007/s11832-008-0079-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-008-0079-z

Keywords

Search

Navigation