Histopathological examination of intervertebral disc specimens: a cost-benefit analysis.
OBJECTIVE
Routine histopathological examination of intervertebral disc specimens is commonly performed in North American hospitals, but recent studies have questioned the utility of this practice in cases where the indication for surgery is a benign process such as degenerative disc disease. In this study, we have performed a cost-benefit analysis of this practice.


METHODS
We performed a cost-benefit analysis of routine histopathological examination of 1775 routine (non-neoplastic and non-infectious indications for surgery) and 70 non-routine (suspected neoplastic or infectious indications for surgery) discectomy specimens obtained over an eight-year period (1996 and 2004). Chart reviews were used to determine if any histopathology findings were clinically significant (i.e., affected subsequent patient care). Total costs were calculated. A literature review was conducted to compare our results with other published series.


RESULTS
We found four unexpected histopathology results among 1775 specimens obtained from routine cases, one of which was clinically significant. We calculated costs of $42,165.25 per unexpected histopathological finding and $168,625 per clinically significant histopathological finding. For non-routine surgeries, the cost per abnormal pathological finding was $116.67.


CONCLUSIONS
In routine cases, histopathological examination of disc specimens is not justified. The decision to send specimens for pathological examination should be based on the surgeon's judgment.
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Adam S
AS
Wu
Daryl R
DR
Fourney
D003362:Cost-Benefit Analysis; D017586:Diskectomy; D006801:Humans; D015994:Incidence; D007403:Intervertebral Disc / Q000473:pathology* / Q000601:surgery; D010340:Pathology, Surgical / Q000191:economics*; D013122:Spinal Diseases / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery