Multicenter Outcome and Cost Analysis of Circumferential vs. Posterior-only Fusions with Thoracic Pedicle Screw Constructs for Main Thoracic Idiopathic Curves between 70-100 Degrees
Methods: A database query identified 35 patients. Patient demographics, preoperative and postoperative curve measures, surgical data (surgical procedure, length of anesthesia, time in operating room, and spinal implants), and length of hospitalization was tabulated and analyzed for both groups. A previously reported cost/charge analysis model was applied to this data.
Results: Of the 35 patients identified in the SDSG database, 12 underwent APSF and 23 PSF-TPS. Mean age was 13.4 years (10 to 17 years). Preoperative thoracic curve size (APSF, 84.2; PSF-TPS, 78.6 degrees), flexibility (APSF, 36.5; PSF-TPS, 38.9 degrees), final curve correction % (APSF, 72.7%; PSF-TPS, 77.6%) and final curve measurements (APSF, 21.1; PSF-TPS, 17.0 degrees) were similar between the two groups (p>0.05). Cost/charges analysis demonstrated APSF had higher surgeon procedural charges ($21,867 vs. $14,470), anesthesiologist charges ($4327 vs. $2967), and operating room charges ($27,466 vs. $17,826)(p<0 .05).
Conclusions: This multi-center, multi-surgeon study demonstrates PSF-TPS constructs to have equivalent curve correction (PSF-TPS, 77.6% vs. APSF, 72.7%) with lower overall treatment costs when compared to circumferential fusion. Anterior release for large, main thoracic curves between 70 and 100 degrees does not appear necessary with adequate spinal fixation with TPS constructs.
Significance: Concern about the costs of TPS constructs does not appear valid when a circumferential approach is avoided for thoracic AIS curves between 70 and 100 degrees.