Advertisement
Vertebral Augmentation for Spinal Fractures

Vertebral Augmentation for Spinal Fractures

Medical management of vertebral compression fractures costs patients and healthcare systems nearly $14 billion annually, according to recent estimates. Percutaneous vertebroplasty and balloon kyphoplasty procedures are being used increasingly for the treatment of these osteoporotic fractures, but the effectiveness and safety of these options are unclear, especially with regard to long-term survival. “Recently, there have been concerns about whether healthcare funding agencies should support these vertebral augmentation procedures as treatment modalities,” says Richard L. Skolasky, ScD. “Evaluating the role of these surgeries on survival, complications, and other parameters may help determine optimal treatment methods.” New Research on Vertebral Augmentation Dr. Skolasky and colleagues had a study published in the Journal of Bone & Joint Surgery that compared various aspects of the management of 69,000 Medicare patients in whom new vertebral compression fractures were treated with vertebroplasty, kyphoplasty, or non-operative modalities. The investigators examined differences in survival at 6 months, 1 year, 2 years, and 3 years in addition to complications, length of hospital stay, charges, 30-day readmission rates, and repeat procedures. According to the results, the overall survival rate for the entire study population was 77.8% at 1 year and 49.6% at 3 years. The kyphoplasty group had the highest survival rates at 1 and 3 years. Patients treated without surgery were hospitalized on average about 8 days longer than patients treated with surgery. However, total charges for kyphoplasty and vertebroplasty were $12,032 and $7,805 more than for non-operative treatment. There was no statistically significant difference in post-operative infections and neurologic complications between surgical and non-surgical patients. Surgically treated patients were less likely to be diagnosed with pneumonia or...
Analyzing Trends in Dollars Spent for Back & Neck Conditions

Analyzing Trends in Dollars Spent for Back & Neck Conditions

More than half of all adults will experience back or neck pain at some point during their lifetime, and these health issues currently rank as the second most common reason for medical visits, trailing only upper respiratory infections. Recently, expenditures on spinal conditions in the United States have increased significantly despite few changes in the overall health status of people who experience these conditions. Estimates vary, but it is generally believed that about $90 billion is spent on the diagnosis and management of low back and neck pain each year. An additional $10 to $20 billion annually is attributed to economic losses in productivity. “Little is known about the pattern of expenditures for different health services for managing patients with back and neck pain,” says Jon D. Lurie, MD, MS. “While it has been generally accepted that medical care costs per unit have become more expensive, few analyses have explored costs relating to other non-medical services, such as chiropractic care and physical therapy.” A Deeper Review of Back & Neck Expenditures It is important for health policy makers to examine expenditures on the different ambulatory health services for back and neck conditions, according to Dr. Lurie. “This information can provide insights into the effects of health policy decisions and inform future strategies for containing costs. A better understanding of spending patterns on health services is needed to gain a better picture of the overall cost and effectiveness of spinal interventions to improve health.” Using data from the Calgary Chiropractic Doctors Association and the Medical Expenditure Panel Survey, Dr. Lurie and colleagues reviewed U.S. expenditures on common health services used...

Comparing Treatments in Vertebral Fractures

Percutaneous therapy for treating patients with bony malignancy and vertebral fractures appears to significantly reduce costs and lengths of stay when compared with surgery. A retrospective review demonstrated that overall costs were $13,565 less and inpatient stays were 4.1 days shorter with percutaneous therapy when compared with surgery. Abstract: Journal of Vascular and Interventional Radiology, November...

Preventing Paralysis During Spinal Surgery

Paraparesis, paraplegia, and quadriplegia are potential complications of spinal cord surgeries or procedures that put the spinal cord at risk. Intraoperative monitoring can alert surgeons and anesthesiologists when patients are at risk for these complications, allowing for prompt treatment to reduce patient harm when warnings are raised. Surgery can then be modified through various interventions, such as reducing the degree of distraction, adjusting retractors, removing or adjusting grafts or hardware, reimplanting or unclamping arteries, and placing vascular bypass grafts. Time to Take a Closer Look at Spinal Surgery In the February 21, 2012 issue of Neurology, my colleagues and I at the American Academy of Neurology and American Clinical Neurophysiology Society published an evidence-based guideline update on intraoperative spinal monitoring with somatosensory and motor evoked potentials. The guideline update was needed because the field of intraoperative spinal monitoring has been growing substantially, causing carriers to ask questions about its utility and ability to predict adverse surgical outcomes. Community hospitals are also beginning to look into intraoperative spinal monitoring as a service that they can provide. With changes in coding from the American Medical Association also occurring, it was a good time to answer these questions based on the current literature in evidence-based medicine. Intraoperative spinal monitoring involves monitoring sensory pathways by applying electrical pulses to the ankles or wrists. These pulses are carried up to the brain and recorded at the scalp. To reach the scalp, the pulses must travel up an intact spinal cord. The motor pathway is the exact opposite; electrical pulses are applied to the brain via the scalp. These pulses are recorded at the peripheral...
Page 1 of 212
[ HIDE/SHOW ]