Glenn Buttermann, Sarah Hollmann, John-Michael Arpino, Nicole Ferko


October 2019, pp 1 - 14 Original Article Read Full Article 10.1007/s00586-019-06165-0

First Online: 03 October 2019

Value of single-level circumferential fusion: a 10-year prospective outcomes and cost-effectiveness analysis comparing posterior facet versus pedicle screw fixation

Purpose

To compare the clinical and economic outcomes of facet versus pedicle screw instrumentation for single-level circumferential lumbar spinal fusion.

Methods

Outcomes included self-assessment of back and leg pain, pain drawing, ODI, pain medication usage, and procedure success. The CEA was based on the 10-year data collected, and the base-case was from a US payer perspective. Costs included the index surgery, additional surgeries, outpatient/ED visits, and medications. To determine quality-adjusted life years (QALYs), ODI scores were used to predict SF-6D utilities. Sensitivity analyses were performed from a modified payer perspective including device costs and from a societal perspective including productivity loss. Discounted and undiscounted incremental costs and QALYs were calculated. Bootstrapping was performed to estimate the distribution of incremental costs and effects.

Results

Clinical improvement was significant from pre-op to 10-year follow-up for both groups (p  1 year (p 

Conclusion

One-level circumferential spinal fusion using facet screws was clinically superior and provided cost savings compared with pedicle screw instrumentation in the USA.

Graphic abstract

[Figure not available: see fulltext.]


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