New Technologies in Spinal Surgery – Financial Costs vs. Clinical Outcomes - 3 Years Experience

Background: The 21^st century provides fast technological improvements in surgery, and in particular in Spinal Surgery. New technologies carry high costs to medical centers and to patients. The benefits of new technologies are sometimes questioned vs. their clinical outcomes, comparing to old school but more evidenced methods.

This study aims to examine the clinical outcomes of different technological approaches in similar clinical cases – L4-L5 Discopathies and instabilities, Av. age 60-80, 61% female.

Material & Methods: L4-L5 Laminectomy and poste-lateral fusion (bone graft) – 26 cases, Av. cost 5,000€

L4-L5 Posterior spinal fusion with pedicle screws – 52 cases, Av. cost 6,500€

L4-L5 Interbody Fusion alone (Cage) – (2000-2005) – 27 cases, Av. cost 6,100€

L4-L5 Decompression and inter-laminar U device – 45 cases, Av. cost 6,100€

L4-L5 posterior spinal fusion with interbody fusion (360) – 6 cases, Av. cost 7,800€

L4-L5 Robotic guided posterior fusion – 18 cases, Av. cost 10,000€

Procedures were compared in surgery time, hospitalization time, complication rate, fluoroscopic exposures, rehabilitation time and procedure costs.

Results: Procedure outcomes were similar in hospitalization time, complications rate and rehabilitation time.

We have evidenced a shorter surgery time in newer technologies as in to U device with Av. time of 55 min. compared to Laminectomy with Av. time of 86 min but shorter than 360 with Av. time of 176 min.

We have evidenced a shorter fluoroscopic exposure in Laminectomy with one shot vs. 22 shots in 360 and 29 shots in posterior spinal fusion.

We have evidenced a significant difference in procedure costs with new technologies which were 63% more costly than old school technologies.

Conclusion: In our experience new technologies have not always proven a better clinical outcomes compared to older methods, while taking into consideration their significantly higher costs. Benefits of these technologies are mainly to surgical staff, but patient outcomes are similar.