title: Economics of image guidance and navigation in spine surgery.
abstract: BACKGROUND
  Image-guidance and navigation in spinal surgery is becoming more widely utilized. Several studies have shown the use of this technology to increase accuracy of pedicle screw placement, decrease the rates of revision surgery, and minimize radiation exposure. In this paper, the authors analyze the economics of image-guided surgery (IGS) and navigation in spine surgery.
  
  
  METHODS
  A literature review was performed using PubMed, the CEA Registry, and the National Health Service Economic Evaluation Database. Each article was screened for inclusion and exclusion criteria, including costs, reoperation, readmission rates, operating room time, and length of stay.
  
  
  RESULTS
  Thirteen studies were included in the analysis. Six studies were identified to meet the inclusion criteria for reporting costs and seven met the criteria for analysis of efficacy. Average costs ranged from $17,650 to $39,643. Pedicle screw misplacement rates using IGS ranged from 1.20% to 15.07% while reoperation rates ranged from 0% to 7.42%.
  
  
  CONCLUSIONS
  There is currently an insufficient amount of studies reporting on the economics of spinal navigation to accurately conclude on its cost-effectiveness in clinical practice. Although a few of these studies showed less costs associated with intraoperative imaging, none were able to establish a statistically significant difference. Preliminary findings drawn from this study indicate a possible cost-effectiveness advantage with IGS, but more comprehensive data on costs need to be reported in order to validate its utilization.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
authors.forename: Lutfi
authors.initials: L
authors.lastname: Al-Khouja
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
authors.forename: Faris
authors.initials: F
authors.lastname: Shweikeh
authors.affiliation: Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Pashman
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA ; Department of Neurosurgery, University of California Davis Medical Center, Sacramento, California, USA.
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Johnson
authors.affiliation: Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, USA.
authors.forename: Terrence T
authors.initials: TT
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
keywords: Costs; fluoroscopy; image-guidance; navigation; reoperation