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Histopathological Examination of Intervertebral Disc Specimens: A Cost-Benefit Analysis

Published online by Cambridge University Press:  02 December 2014

Adam S. Wu  and
Daryl R. Fourney
Adam S. Wu
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Daryl R. Fourney
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Abstract

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Object:

Routine histopathological examination of intervertebral disc specimens is commonly performed in North American hospitals, but recent studies have questioned the utility of this practice in cases where the indication for surgery is a benign process such as degenerative disc disease. In this study, we have performed a cost-benefit analysis of this practice.

Methods:

We performed a cost-benefit analysis of routine histopathological examination of 1775 routine (non-neoplastic and non-infectious indications for surgery) and 70 non-routine (suspected neoplastic or infectious indications for surgery) discectomy specimens obtained over an eight-year period (1996 and 2004). Chart reviews were used to determine if any histopathology findings were clinically significant (i.e., affected subsequent patient care). Total costs were calculated. A literature review was conducted to compare our results with other published series.

Results:

We found four unexpected histopathology results among 1775 specimens obtained from routine cases, one of which was clinically significant. We calculated costs of $42,165.25 per unexpected histopathological finding and $168,625 per clinically significant histopathological finding. For non-routine surgeries, the cost per abnormal pathological finding was $116.67.

Conclusions:

In routine cases, histopathological examination of disc specimens is not justified. The decision to send specimens for pathological examination should be based on the surgeon's judgment.

Résumé:

RÉSUMÉ:<span class='italic'><span class='bold'>But</span></span>:

Dans les hôpitaux nord- américains, les spécimens de disques intervertébraux sont examinés de routine en anatomopathologie. Cependant, des études récentes ont remis en question la pertinence de cette pratique dans les cas où l’indication chirurgicale est une pathologie bénigne comme une maladie discale dégénérative. Cette étude porte sur le ratio coût-bénéfice de cette pratique.

<span class='italic'><span class='bold'>Méthodes</span></span>:

Nous avons effectué une analyse coût-bénéfice de l’examen anatomopathologique fait de routine entre 1996 et 2004 sur 1775 spécimens provenant de discectomies faites de routine (indications chirurgicales non néoplasiques et non infectieuses) et 70 spécimens provenant de discectomies chez des patients chez qui on soupçonnait une néoplasie ou une infection. La revue des dossiers a permis de déterminer si les constatations anatomopathologiques étaient significatives au point de vue clinique, c’est-à-dire si elles avaient influencé le traitement du patient. Nous avons calculé le coût total. Une revue de la littérature nous a permis de comparer nos résultats à ceux d’autres chercheurs.

<span class='italic'><span class='bold'>Résultats</span></span>:

Nous avons découvert 4 comptes rendus anatomopathologiques inattendus parmi les 1775 spécimens provenant des cas de routine, dont un était significatif au point de vue clinique, à un coût de 42 165,25 $ par trouvaille anatomopathologique et de 168 625 $ par trouvaille anatomopathologique significative au point de vue clinique. Pour les chirurgies qui n’étaient pas faites de routine, le coût par constatation anatomopathologique anormale était de 116,67 $.

<span class='italic'><span class='bold'>Conclusions</span></span>:

Quand il s’agit de cas de routine, l’examen anatomopathologique des spécimens de disques n’est pas justifié. La décision de demander un examen anatomopathologique de ces spécimens chirurgicaux devrait être basée sur le jugement du chirurgien.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 4 , November 2007 , pp. 451 - 455
Copyright
Copyright © The Canadian Journal of Neurological 2007

References

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