A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: cost-effective assessment from the Total Posterior Spine system (TOPS) IDE Study: 2-year model revision and sensitivity analyses based on 305 subjects.

Background Context: A previous cost-effectiveness analysis published in 2022 found that the Total Posterior Spine (TOPS) system was dominant over transforaminal lumbar interbody fusion (TLIF). This analysis required updating to reflect a more complete dataset and pricing considerations.

Purpose: To evaluate the cost-effectiveness of TOPS system as compared with TLIF based on an updated and complete FDA investigational device exemption (IDE) data set.

Intraoperative neuromonitoring in spine surgery: large database analysis of cost-effectiveness.

Background: Given the increased attention to functional improvement in spine surgery as it relates to activities of daily living and cost, it is critical to fully understand the health care economic impact of enabling technologies. The use of intraoperative neuromonitoring (IOM) during spine surgery has long been controversial. Questions pertaining to utility, medico-legal considerations, and cost-effectiveness continue to be unresolved.

A Systematic Review and Meta-Analysis of Silicon Nitride and Biomaterial Modulus as it Relates to Subsidence Risk in Spinal Fusion Surgery.

Introduction: For decades, researchers and surgeons have sought to determine the optimal biomaterial for spinal fusion implants. Successful fusion is associated with improved quality of life while failures are often associated with costly and complex revisions. One common failure is subsidence.

A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis: Early Cost-effective Assessment from the Total Posterior Spine System (TOPS™) IDE Study.

Given the increased attention to functional improvement in spine surgery as it relates to motion preservation, activities of daily living, and cost, it is critical to fully understand the healthcare economic impact of new devices being tested in large FDA randomized controlled trials (RCT). The purpose of this analysis was to comprehensively evaluate the cost-effectiveness of the novel Total Posterior Spine (TOPS™) System investigational device compared with the trial control group, standard transforaminal lumbar interbody fusion (TLIF). To evaluate the cost-effectiveness of TOPS™ compared with TLIF.

Reduction of direct costs in high-risk lumbar discectomy patients during the 90-day post-operative period through annular closure.

Purpose: Despite being an extremely successful procedure, recurrent disc herniation is one of the most common post-discectomy complications in the lumbar spine and contributes significant health care and socioeconomic costs. Patients with large annular defects are at a high risk for reherniation, but an annular closure device (ACD) has been designed to reduce reherniation risk in this population and may, in turn, help control direct health care costs after discectomy.

Patients And Methods: This analysis examined the 90-day post-discectomy cost estimates among ACD-treated (n=272) and control (discectomy alone; n=278) patients in a randomized controlled trial (RCT).

Postoperative direct health care costs of lumbar discectomy are reduced with the use of a novel annular closure device in high-risk patients.

Background Context: Lumbar discectomy is largely successful surgical procedure; however, reherniation rates in patients with large annular defects are as high as 27%. The expense associated with a revision surgery places significant burden on the healthcare system.

Purpose: To compare the direct health care costs through 5 years follow-up of conventional discectomy (Control) with those of discectomy supplemented by an adjunctive annular closure device (ACD) in high-risk patients with large annular defects.

Treatment of cervical radiculopathy: A review of the evolution and economics.

Background: The surgical treatment of cervical radiculopathy has centered around anterior cervical discectomy and fusion (ACDF). Alternatively, the posterior cervical laminoforaminotomy/microdiscectomy (PCF/PCM), which results in comparable outcomes and is more cost-effective, has been underutilized.

Methods: Here, we compared the direct/indirect costs, reoperation rates, and outcome for ACDF and PCF vs.

Cost-Effectiveness of Endoscopic Versus Microscopic Transsphenoidal Surgery for Pituitary Adenoma.

Background: Endoscopic transsphenoidal surgery (ETPS) has become increasingly popular for resection of pituitary tumors, whereas microscopic transsphenoidal surgery (MTPS) also remains a commonly used approach. The economic sustainability of new techniques and technologies is rarely evaluated in the neurosurgical skull base literature. The aim of this study was to determine the cost-effectiveness of ETPS compared with MTPS.

Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience.

Background: The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education.

Medical necessity of routine admission of children with mild traumatic brain injury to the intensive care unit.

OBJECTIVE Approximately 475,000 children are treated for traumatic brain injury (TBI) in the US each year; most are classified as mild TBI (Glasgow Coma Scale [GCS] Score 13-15). Patients with positive findings on head CT, defined as either intracranial hemorrhage or skull fracture, regardless of severity, are often transferred to tertiary care centers for intensive care unit (ICU) monitoring. This practice creates a significant burden on the health care system.

Understanding United States Investigational Device Exemption Studies-Clinical Relevance and Importance for Healthcare Economics.

Introduction: The US Food and Drug Administration allows a previously unapproved device to be used clinically to collect safety and effectiveness data under their Investigational Device Exemption (IDE) category. The process usually falls under 3 different trial categories: noninferiority, equivalency, and superiority. To confidently inform our patients, understanding the basic concepts of these trials is paramount.

Cost Utility Analysis of the Cervical Artificial Disc vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease: 5-Year Follow-up.

Background: The cervical total disc replacement (cTDR) was developed to treat cervical degenerative disc disease while preserving motion.

Objective: Cost-effectiveness of this intervention was established by looking at 2-year follow-up, and this update reevaluates our analysis over 5 years.

Methods: Data were derived from a randomized trial of 330 patients.

A Novel Quality-of-Life Utility Index in Patients With Multilevel Cervical Degenerative Disc Disease: Comparison of Anterior Cervical Discectomy and Fusion With Total Disc Replacement.

Study Design: Decision analysis from prior randomized controlled trial (RCT) data.

Objective: To describe the importance of developing baseline utility indices while identifying effective treatment options for cervical spine disease.

Summary Of Background Data: Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis while preserving motion.

Sequential Changes of Plasma C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Spine Surgery : Comparison between Lumbar Open Discectomy and Posterior Lumbar Interbody Fusion.

Objective: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often utilized to evaluate for postoperative infection. Abnormal values may be detected after surgery even in case of non-infection because of muscle injury, transfusion, which disturbed prompt perioperative management. The purpose of this study was to evaluate and compare the perioperative CRP, ESR, and white blood cell (WBC) counts after spine surgery, which was proved to be non-infection.

Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease.

Importance: Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis, while preserving motion. While anterior cervical discectomy and fusion (ACDF) has been the standard of care for 2-level disease, a randomized clinical trial (RCT) suggested similar outcomes. Cost-effectiveness of this intervention has never been elucidated.

Health impact and economic analysis of NGO-supported neurosurgery in Bolivia.

Object: Bolivia, one of the poorest countries in the world, ranks 108th on the 2013 Human Development Index. With approximately 1 neurosurgeon per 200,000 people, access to neurosurgery in Bolivia is a growing health concern. Furthermore, neurosurgery in nonindustrialized countries has been considered both cost-prohibitive and lacking in outcomes evaluation.

Standardizing cost-utility analysis in neurosurgery.

This review seeks to introduce the concept of cost-utility analysis in neurosurgery and to highlight its essential components. It also includes a suggested approach to standardization, which would help bring more credence to this research and potentially affect management choices, reimbursement, and policy.

Risk factors for the development of retroprosthetic membranes with Boston keratoprosthesis type 1: multicenter study results.

Objective: The purpose of this study was to identify possible risk factors for retroprosthetic membrane (RPM) development in a large, multicenter cohort of patients receiving a Boston type 1 keratoprosthesis.

Design: Cohort study.

Participants: The final analysis included 265 eyes of 265 patients who underwent implantation of a Boston keratoprosthesis type I device between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centers.

Titanium back plate for a PMMA keratoprosthesis: clinical outcomes.

Background/purpose: To compare the rate of retroprosthetic membrane (RPM) formation in Boston Keratoprosthesis (BKPro) with polymethyl methacrylate (PMMA) versus titanium backplates.

Design: Retrospective comparative chart review.

Methods: Multicenter study population: a total of 78 eyes with keratoprosthesis implants with either PMMA or titanium backplates were included in the study.

Transient extremity ischemia augments CD34+ progenitor cell availability.

Peripheral blood is an easily accessed source for stem cell production; however, the number of cells produced is relatively low. We hypothesized that ischemic preconditioning may serve as a safe method to increase the number of CD34+ cells that can be harvested and cultured in a short period. This study was conducted to test this hypothesis by examining the safety and efficacy of brief, transient ischemia of the lower limbs to augment the number of cells that can be produced from blood of healthy volunteers.

Cost-effectiveness of the Boston keratoprosthesis.

Purpose: To conduct a cost-utility analysis and determine the cost-effectiveness of the Boston Keratoprosthesis (Boston Kpro).

Design: Retrospective cohort study.

Methods: setting: The Massachusetts Eye and Ear Infirmary corneal service.

The Boston Keratoprosthesis: comparing corneal epithelial cell compatibility with titanium and PMMA.

Purpose: To determine in vitro whether titanium is superior in corneal cell compatibility to standard polymethyl-methacrylate (PMMA) for the Boston Keratoprosthesis (KPro).

Methods: Human corneal-limbal epithelial (HCLE) cells were cultured 24, 48, 72, 96, 120, 144, or 168 hours in culture plates alone (controls) or with PMMA or titanium discs. Experiments were performed in triplicate and repeated (final n = 6).