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Antonio Faundez, Wendy Thompson, and J.-C. Le Huec

Antonio Faundez

Service de Chirurgie Orthopédique et Traumatologie de l’Appareil Moteur, Geneva college Hospital, Geneva, Switzerland

Wendy Thompson

Université Bordeaux Ségalen, Unité Ortho-Rachis 2, Pôle Chirurgie, CHU Pellegrin, Bordeaux, France

J.-C. Le Huec

Université Bordeaux Ségalen, Unité Ortho-Rachis 2, Pôle Chirurgie, CHU Pellegrin, Bordeaux, France

Service de Chirurgie Orthopédique et Traumatologie de l’Appareil Moteur, Geneva college Hospital, Geneva, Switzerland
Université Bordeaux Ségalen, Unité Ortho-Rachis 2, Pôle Chirurgie, CHU Pellegrin, Bordeaux, France
Corresponding author.

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Learning targets

Watch surgical treatment online

New options for cost efficiency in spine surgery


The number of spinal surgeries has actually been steadily increasing these critical years because of a constant ageing of the population. In the USA, the rate of instrumented combination has tremendously increased due to the fact that 1996 and cost-effectiveness has end up being a major concern <1, 2>.

There is therefore a need to enhance cost-effectiveness at all stages the the therapeutic procedure of spinal instrumented fusion.

Case description

The patience is a 52-year-old man who has complied with a more than 6-month non-surgical therapy without success. The MRI shows a two-level bowl degeneration in ~ L3–L4 and L4–L5, with central disc herniation at this former level (Fig. 1a, b). As a last resort, that agreed to undergo a posterolateral and also interbody fusion L3–L5. Together in every one of our patients, a in-depth sagittal balance parameters analysis on a low-dose complete spine X-ray was performed to respect patient’s spinopelvic balance (Fig. 2).


Preoperative MRI the the lumbar spine the the treated patient. A two level disc degeneration L3–L5 is seen (a). A central disc herniation is likewise present at the L4–L5 level (b)

Preoperative low radiation dose complete spine X-ray of the patient. Before any kind of surgical treatment, the is causing obligation to analyze spino-pelvic parameters to it is adapted our therapeutic strategy to every individual

Surgical procedure

The patient underwent a two-level classic posterolateral lumbar blend under basic anaesthesia. We supplied a high an innovation instrumentation and also implants, ceded in several completely traceable sterile kits: 2 kits each containing a pair of pre-loaded pedicle screws, one kit of two sterile rods, one collection of sterile implantation instrumentation. The pre-loaded pedicle screws were implanted utilizing a conventional transpedicular technique. Us performed a standard transforaminal interbody fusion using a peek cage filled through allograft. Special treatment was taken to insert the interbody blend cage the many anteriorly possible, to have the ability to gain the most feasible segmental lordosis (cantilever technique) <3>. Posterolateral bone decortication and blend was brought out v a mix of locally harvested autograft, allograft and demineralised bone matrix. The rod’s shape was adjusted to to the right the patient’s lordosis as figured out preoperatively by sagittal balance analysis <4, 5>.

Postoperative information

The patient was allowed to walk openly 2 days ~ surgery. The postoperative course was uneventful and the patient was discharged from the hospital 5 days after ~ surgery. The postoperative low-dose full spine X-ray shown correct implant positioning and also respect of sagittal alignment (Fig. 3).

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Fig. 3

Postoperative full spine X-ray, showing that the worldwide sagittal balance has actually been respected

Discussion and also conclusion

Fusion surgery is a well-documented and well-recognized treatment for several lumbar spine pathologies, indigenous etiologies such together trauma or physiologic degeneration. The variety of lumbar blend surgeries has considerably increased, 77 % in between 1996 and 2001 in the USA and also represents a major health economics issue, even if current reports suggest that cost-effectiveness is boosting with time <1, 2>.

We current here a potentially new cost-efficient technique for lumbar fusion: a high modern technology lumbar pedicle screw and rod combination system, implanted with a disposable instrumentation set. The implants and also instruments are preoperatively sterilized, wrapped and delivered in ready-to-use kits, hence eliminating the usual need for OR nurses to re-sterilize implant and instrumentation sets. The implants are made of classic titanium alloy. Different screw and rod size are accessible in various packages. Instruments are do of a material, which can be recycled after use. Pre-loaded pedicle screws facilitate nurse’s implant manipulation in the operating theatre. One much more advantage is the far-ranging weight palliation of the ready-to-use sterile kits contrasted to classic lumbar fusion kits do of titanium, stainless steel and also aluminium. For example, for a one-level lumbar fusion, this disposable instrumentation and implant kits have actually a complete weight of 2.8 kg, whereas classic re-usable instrumentation trays weigh an typical of 12 kg.

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The outcomes of a preliminary mono-centric observational study have actually recently been published by Thompson et al. <6>. This ready-to-use lumbar blend system was offered to perform lumbar fusions ~ above 12 patients, mean age 60 years. Indications because that surgery contained lumbar pathologies from degenerative or traumatic aetiologies. One or more levels were treated. From a clinical point of view, patients had actually an uneventful postoperative course, after ~ a typical follow-up duration of minimum 6 weeks. The writer have determined several fields of potential surgical cost reduction, consisting of the sterilization procedure (160–204 Euro much less for patient in this study), and the implant elimination process (mean of 0.73 Euro cent per surgery), which is much less than reprocessing the standard instrumentation trays. Those outcomes will have to be shown by further detailed cost-efficiency studies.