title: Conventional versus digital radiographs for intraoperative cervical spine-level localization: a prospective time and cost analysis.
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.
  
  
  OBJECTIVE
  To prospectively evaluate the time and operating room efficiency differences between the two methods for intraoperative level localization. STYDY DESIGN: Prospective nonrandomized study.
  
  
  METHODS
  Prospective consecutive patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) with plate and allograft.
  
  
  METHODS
  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.
authors.affiliation: Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA. steinmm@ccf.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.forename: Ajit
authors.initials: A
authors.lastname: Krishnaney
authors.forename: Michael
authors.initials: M
authors.lastname: Modic
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D003365:Costs and Cost Analysis; D017586:Diskectomy / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000191:economics / Q000379:methods*; D013123:Spinal Fusion / Q000191:economics / Q000379:methods*; D013996:Time and Motion Studies