3D image-guidance platforms have transformed spinal surgery by enhancing visualization, increasing precision, and improving patient outcomes. However, with high procurement, operational, and ...maintenance costs relative to the standard of care, the benefits of acquiring these platforms must be thoroughly assessed. This study aims to develop a model that weighs the cost of a typical 3D navigation platform against its clinical benefits to determine the facility case volume required to justify its purchase. Using Medtronic’s StealthStation and O-Arm as a market example, we calculated the break-even case volume by dividing the cost of the platform by the difference in gross margins between 3D navigation and the standard of care. Total gross margins earned from first-time and revision surgeries were calculated based on each payer’s reimbursement rate and covered case volume, as well as each technology’s revision rate. Values reported in literature and by Centers for Medicare and Medicaid Services databases were plugged into the model to calculate variables. At a 0% reimbursement rate from private payers for revision surgeries, an annual case volume of 158 spinal surgeries would be required to justify the per-year 3D navigation cost; at 100% private payer reimbursement, 352 surgeries would be required. Given these volumes, 61% of all US inpatient facilities cannot justify 3D navigation at 0% reimbursement, and 86% cannot justify it at 100% reimbursement. Accordingly, greater pricing flexibility, such as per-procedure models, is required for 3D navigation systems to standardize clinical outcomes across medical centers.
INTRODUCTION:
3D surgical navigation has revolutionized spinal surgery. However, information on the overall usability of these tools is limited and inconsistent, especially with regard to operative ...time and radiation exposure. Complication rates across institutions and platforms have not been systematically examined, leading to a lack of quantitative understanding on surgical success rates.
METHODS:
This study used PRISMA guidelines and a PROSPERO-registered protocol to identify studies on FDA-approved 3D navigation systems in spinal procedures from Ovid MEDLINE(R), Embase, and Cochrane CENTRAL. Results were assessed by two independent reviewers using inclusion/exclusion criteria and risk of bias tools.
RESULTS:
70 studies, totaling 3500 patients, were included. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.18% and 93.74%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r = 0.49, p = 0.40). 23 studies, totaling 1723 patients, compared the performance of 3D navigation to 2D fluoroscopy or freehand navigation. There was a significant difference of 6.47% between surgical success rates of the interventional and control groups (p = 0.01). However, there was no significant difference in radiation exposure or operative time between 3D navigated procedures and their controls.
CONCLUSIONS:
This study concludes that 3D navigation may have higher surgical success rates than 2D fluoroscopy and freehand navigation; increased surgeon comfort with riskier procedures on more complex segments of the spine may explain the slight increase in complication rates observed since 2004; and there is a need for improvement in 3D navigation tools to decrease operative time and radiation exposure.
Teleproctoring is an emerging method of bedside clinical teaching; however, its feasibility has been limited by the available technologies. The use of novel tools that incorporate 3-dimensional ...environmental information and feedback might offer better bedside teaching options for neurosurgical procedures, including external ventricular drain placement.
A platform with a camera-projector system was used to proctor medical students on placing external ventricular drains on an anatomic model as a proof-of-concept study. Three-dimensional depth information of the model and surrounding environment was captured by the camera system and provided to the proctor who could provide projected annotations in a geometrically compensated manner onto the head model in real time. The medical students were randomized to identify Kocher's point on the anatomic model with or without the navigation system. The time required to identify Kocher's point and the accuracy were measured as a proxy for determining the effectiveness of the navigation proctoring system.
Twenty students were enrolled in the present study. Those in the experimental group identified Kocher's point an average of 130 seconds faster than did the control group (P < 0.001). The mean diagonal distance from Kocher's point was 8.0 ± 4.29 mm for the experimental group compared with 23.6 ± 21.98 mm for the control group (P = 0.053). Of the 10 students randomized to the camera-projector system arm, 70% were accurate to within 1 cm of Kocher's point compared with 40% of the control arm (P > 0.05).
Camera-projector systems for bedside procedure proctoring and navigation are a viable and valuable technology. We demonstrated its viability for external ventricular drain placement as a proof-of-concept. However, the versatility of this technology indicates that that it could be useful for a variety of even more complex neurosurgical procedures.
PDF
