The Spine Journal
Volume 9, Issue 12 , Pages 967-971, December 2009

Conventional versus digital radiographs for intraoperative cervical spine-level localization: a prospective time and cost analysis

  • Michael P. Steinmetz, MD

      Affiliations

    • Center for Spine Health, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA
    • Corresponding Author InformationCorresponding author. Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA. Tel.: (216) 445-4633; fax: (216) 636-5457.
    • ,
  • Thomas E. Mroz, MD

      Affiliations

    • Center for Spine Health, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA
    • ,
  • Ajit Krishnaney, MD

      Affiliations

    • Center for Spine Health, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA
    • ,
  • Michael Modic, MD

      Affiliations

    • Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA

Received 29 September 2008; received in revised form 27 June 2009; accepted 20 July 2009. published online 28 August 2009.

Abstract 

Background

In today's health-care environment, operational efficiency is intrinsic to balancing the need for increased productivity driven by rising costs and potentially decreasing reimbursement. Other operational factors kept constant, decreasing the time for a procedure can be viewed as one marker for increased efficiency.

Purpose

To prospectively evaluate the time and operating room efficiency differences between the two methods for intraoperative level localization.

Stydy design

Prospective nonrandomized study.

Patient sample

Prospective consecutive patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) with plate and allograft.

Outcomes measures

Time for performance and interpretation of intraoperative localization radiograph.

Methods

This is a prospective nonrandomized study of patients treated consecutively with a single-level ACDF with allograft and plating. All the patients underwent a conventional approach to the cervical spine. After exposure, a spinal needle was placed in the exposed intervertebral disc and a radiography was performed. Either a conventional or a digital radiography was used in each case.

Results

Eighteen patients were enrolled in this study. Ten patients underwent localization with conventional radiography, whereas eight patients underwent localization with digital imaging. The mean time for conventional radiography was 823 seconds (standard deviation [SD], 159), and for digital, it was 100 seconds (SD, 34; p<.001).

Conclusions

Current technology provides options for level localization. Digital imaging provides equally accurate information as conventional radiography in a significantly reduced amount of time. Image quality, ease or archival, and manipulation provided by digital radiography are superior to those by provided fluoroscopy. Keeping operational factors constant, decreasing the time for a procedure, and increasing the efficiency of the environment may be viewed as a surrogate for improving the cost basis for a procedure.

Keywords: ACDF, Cervical, Fusion, Localization radiograph, Socioeconomics, Spine

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 FDA device/drug status: not applicable.

 Author disclosures: MPS (speaking/teaching arrangements, Stryker Spine); TEM (stock ownership, PearlDiver, Inc.).

PII: S1529-9430(09)00327-1

doi:10.1016/j.spinee.2009.07.004

The Spine Journal
Volume 9, Issue 12 , Pages 967-971, December 2009

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