Comparison between anterior and posterior decompression for cervical spondylotic myelopathy: subjective evaluation and cost analysis

Liu, Bin; Wei, Ma; Zhu, Feng; Guo, Chenguang; Yang, Wenlong

doi:10.1111/j.1757-7861.2011.00169.x

Cited by 21 publications

(13 citation statements)

References 14 publications

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“…The finding of higher third-party payments for the treatment of patients undergoing a posterior approach is consistent with the previously reported literature. [17][18][19] Our findings are supported by those of Shamji et al, who showed that resource utilization was significantly higher for patients undergoing a posterior approach for diffuse cervical spondylosis. 23 In the current study, we did not separate fusion from nonfusion posterior procedures, which could impact the rates of reimbursement.…”

Section: Discussionsupporting

confidence: 87%

“…Each approach has specific advantages and disadvantages, and controversy remains in terms of the optimal approach for subgroups of patients. 15,16,18,19,23 A systematic review by Lawrence et al did not demonstrate any clear advantage to either the anterior or posterior surgical approach for patients with multilevel CSM. 17 The authors recommended an individualized approach for patients with CSM based on patient and disease characteristics.…”

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confidence: 96%

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Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases

Virk

Phillips

Khan

2018

Journal of Neurosurgery: Spine

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OBJECTIVECervical spondylotic myelopathy (CSM) is a progressive spinal condition that often requires surgery. Studies have shown the clinical equivalency of anterior versus posterior approaches for CSM surgery. The purpose of this study was to determine the amount and type of resources used for anterior and posterior surgical treatment of CSM by using large national databases of clinical and financial information from patients.METHODSThis study consists of 2 large cohorts of patients who underwent either an anterior or posterior approach for treatment of CSM. These patients were selected from the Medicare 5% National Sample Administrative Database (SAF5) and the Humana orthopedic database (HORTHO), which is a database of patients with private payer health insurance. The outcome measures were the cost of a 90-day episode of care, as well as a breakdown of the cost components for each surgical procedure between 2005 and 2014.RESULTSA total of 16,444 patients were included in this analysis. In HORTHO, there were 10,332 and 1556 patients treated with an anterior or posterior approach for CSM, respectively. In SAF5, there were 3851 and 705 patients who were treated by an anterior or posterior approach for CSM, respectively. The mean ± SD reimbursements for anterior and posterior approaches in the HORTHO database were $20,863 ± $2014 and $23,813 ± $4258, respectively (p = 0.048). The mean ± SD reimbursements for anterior and posterior approaches in the SAF5 database were $18,219 ± $1053 and $25,598 ± $1686, respectively (p < 0.0001). There were also significantly higher reimbursements for a rehabilitation/skilled nursing facility and hospital/inpatient care for patients who underwent a posterior approach in both the private payer and Medicare databases. In all cohorts in this study, the hospital-related reimbursement was more than double the surgeon-related reimbursement.CONCLUSIONSThis study provides resource utilization information for a 90-day episode of care for both anterior and posterior approaches for CSM surgery. There is a statistically significant higher resource utilization for patients undergoing the posterior approach for CSM, which is consistent with the literature. Understanding the reimbursement patterns for anterior versus posterior approaches for CSM will help providers design a bundled payment for patients requiring surgery for CSM, and this study suggests that a subset of patients who require the posterior approach for treatment also require greater resources. The data also suggest that hospital-related reimbursement is the major driver of payments.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 96%

Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases

Virk

Phillips

Khan

2018

Journal of Neurosurgery: Spine

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“…Fourteen studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26] reporting the SF36 outcomes of 1966 patients with degenerative cervical myelopathy were included, while excluding 181 studies during study selection stage (Appendix 1). Because many studies had more than 1 arm, 22 datasets were obtained.…”

Section: Resultsmentioning

confidence: 99%

SF36 Is a Reliable Patient-Oriented Outcome Evaluation Tool in Surgically Treated Degenerative Cervical Myelopathy Cases: A Systematic Review and Meta-Analysis

Wang¹,

Dong

2019

Med Sci Monit

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BackgroundDegenerative spinal disorders have adverse impacts on patients’ quality of life. Because the main objectives of any surgical intervention are to improve health-related quality of life and to reduce disability, instruments capable of measuring patient-oriented outcomes are now increasingly used. The aim of this study was to evaluate the use of the Short Form 36 Health Survey Questionnaire (SF36) for assessing patient-oriented outcomes of degenerative cervical myelopathy surgery.Material/MethodsA literature search was conducted in electronic databases (Google Scholar, Ovid SP, PubMed, Science Direct, and Springer). Studies were included if they reported SF36 scores by following patients for at least 12 months. Random effects meta-analyses were performed to estimate changes in SF36 physical/mental component summary (SF36-PCS/MCS), SF36 dimensional, Japanese Orthopedics Association (JOA)/modified JOA (mJOA), and Neck Disability Index (NDI) scores by latest follow-up.ResultsFourteen studies (1966 patients; age 58.2 years [95% confidence interval (CI), 56.6 to 59.9]; 60% males [95% CI, 55 to 64]; follow-up 24.8 months [95% CI, 20.9 to 28.7]) were included in meta-analysis. SF36-PCS (6.60 [95% CI, 4.91 to 8.28]; p<0.00001), SF36-MCS (6.33 [95% CI, 4.31 to 8.35]; p<0.00001) and SF36 dimensional (p<0.05) scores improved significantly at latest follow-up. Surgery significantly improved JOA/mJOA (3.43 [95% CI, 2.80 to 4.06]; p<0.00001) and NDI (−13.70 [95% CI, −17.35 to −10.06]; p<0.00001) scores also. Change in SF36-PCS score were correlated (r=−0.554) with change in NDI score, whereas change in SF36-MCS score was correlated with change in JOA score (r=0.550).ConclusionsSurgery for degenerative cervical myelopathy is associated with significantly improved SF36-measured patient-oriented outcomes.

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“…Cervical spondylotic myelopathy (CSM) is a degenerative disorder of the cervical spine characterized by narrowing of the cervical spinal canal and compression of the spinal cord. Clinical manifestations of CSM may include symptoms such as paresthesia in the upper limbs, spastic paraparesis, impaired sensation, and gait disturbance. When cervical medullary are compressed to a certain degree, gait abnormalities such as unsteady walking and impaired balance may be observed; such abnormalities are a strong indication for surgical intervention and can be used as an index to assess postoperative recovery.…”

Section: Introductionmentioning

confidence: 99%

Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases

Zheng

Liu

et al. 2016

Orthopaedic Surgery

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Comparison between anterior and posterior decompression for cervical spondylotic myelopathy: subjective evaluation and cost analysis

Cited by 21 publications

References 14 publications

Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases

Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases

SF36 Is a Reliable Patient-Oriented Outcome Evaluation Tool in Surgically Treated Degenerative Cervical Myelopathy Cases: A Systematic Review and Meta-Analysis

Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases

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