Although histopathological grading systems for disc degeneration are frequently used in research, they are not yet integrated into daily care routine pathology of surgical samples. Therefore, data on histopathological changes in surgically excised disc material and their correlation to clinical parameters such as age, gender or body mass index (BMI) is limited to date. The current study was designed to correlate major physico-clinical parameters from a population of orthopaedic spine center patients (gender, age and BMI) with a quantitative histologic degeneration score (HDS). Excised lumbar disc material from 854 patients (529 men/325 women/mean age 56 (15-96) yrs.) was graded based on a previously validated histologic degeneration score (HDS) in a cohort of surgical disc samples that had been obtained for the treatment of either disc herniation or discogenic back pain. Cases with obvious inflammation, tumor formation or congenital disc pathology were excluded. The degree of histological changes was correlated with sex, age and BMI. The HDS (0-15 points) showed significantly higher values in the nucleus pulposus (NP) than in the annulus fibrosus (AF) (Mean: NP 11.45/AF 7.87), with a significantly higher frequency of histomorphological alterations in men in comparison to women. Furthermore, the HDS revealed a positive significant correlation between the BMI and the extent of histological changes. No statistical age relation of the degenerative lesions was seen. This study demonstrated that histological disc alterations in surgical specimens can be graded in a reliable manner based on a quantitative histologic degeneration score (HDS). Increased BMI was identified as a positive risk factor for the development of symptomatic, clinically significant disc degeneration.

/pdf/histological-analysis-of-surgical-lumbar-intervertebral-disc-114bflpkvk.pdf

Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index

Background
Many hospitals require all operative specimens be sent to pathologists for routine examination. Although previous studies indicate this practice increases medical cost, it remains unclear whether it alters patient management and whether it is cost-effective.

/pdf/histologic-examinations-of-arthroplasty-specimens-are-not-zw7l781qxb.pdf

Histologic Examinations of Arthroplasty Specimens are not Cost-effective: A Retrospective Cohort Study

Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression. A cost-benefit analysis retrospective study.

Object. Given the virtual absence of histologically detected, clinically unsuspected disease in intervertebral disc specimens, some authors have advocated that histological examination be discontinued. However, the examination of intervertebral disc specimens remains common practice in most pathology laboratories. No cost—benefit analysis of this practice has been made; therefore, the authors' goal in this study was perform such an analysis. Methods. Using the University of Iowa surgical pathology database, 1109 patients who had undergone a laminectomy were identified retrospectively. These cases were classified into four categories based on the patients' preoperative clinical diagnosis and final histopathological diagnosis: insignificant clinical diagnosis/insignificant pathological diagnosis (ICIP), significant clinical diagnosis/insignificant pathological diagnosis (SCIP), significant clinical diagnosis/significant pathological diagnosis (SCSP), and insignificant clinical diagnosis/significant patholog...

Cost—benefit value of microscopic examination of intervertebral discs

Background: While the clinical value of routine pathologic examination of tissues removed during orthopaedic procedures has not been determined, limited cost-effectiveness and a low prevalence of findings that alter patient management have been previously demonstrated with arthroscopy. The purpose of this study was to examine the clinical value and cost-effectiveness of routine histological examination of knee arthroscopy specimens.

Methods: Retrospective chart analysis of 3797 consecutive knee arthroscopies by two surgeons from 2004 to 2013 at three affiliated hospitals within one health-care system was undertaken. Pathology reports regarding tissue removed during partial meniscectomies and anterior cruciate ligament reconstructions were reviewed to determine if the results altered patient care. The total costs of histological examination were estimated in 2012-adjusted U.S. dollars. The cost per health effect was determined by calculating the cost per discrepant and discordant diagnosis.

Results: The prevalence of concordant diagnoses was 99.3% (3769 of 3797), the prevalence of discrepant diagnoses was 0.7% (twenty-seven of 3797), and the prevalence of discordant diagnoses was 0.026% (one of 3797). The total cost of histological examinations was estimated to be $371,810. The total cost of the pathology cost per discrepant diagnosis was $13,771, and the cost per discordant diagnosis was $371,810.

Conclusions: Routine pathological examination of surgical specimens from patients undergoing knee arthroscopy had limited cost-effectiveness because of the low prevalence of findings that altered patient management. Histological examination of surgical specimens from arthroscopic knee surgery did not alter patient care and increased costs. We suggest that gross and histological examination of tissue removed during knee arthroscopy should be done at the discretion of the orthopaedic surgeon rather than being mandatory.

Routine Examination of Pathology Specimens Following Knee Arthroscopy: A Cost-Effectiveness Analysis.

Study Design. A retrospective chart review was performed from 1990-1994. Objectives. To evaluate the outcome of pathologic examination on cervical disc specimens submitted after anterior cervical discectomy. Summary of Background Data. This study is the first to review the outcome of pathologic examination of disc specimens after anterior cervical discectomy and fusion. Methods. Charts were reviewed based on the procedure code of anterior cervical fusion and the main diagnoses of cervical disc and spondylosis. The following data were recorded for each patient: symptoms, examination, diagnostic studies, operative procedure, operative findings, and pathology report. Statistical analysis was performed. Results. Five hundred six disc levels in 394 patients reviewed. All patients had symptoms and examination results consistent with cervical radiculopathy. All patients, had cervical radiographs and some combination of myelography, computed tomography, or magnetic resonance imaging. Findings at the time of surgery included the presence of either a herniated disc or degenerative spondylitic changes. The pathologic examination results of all specimens reported fibrocartilaginous tissue consistent with disc material with the presence of degenerative changes. No infectious, benign, or malignant process was identified at the time of surgery or on gross and histologic examination of any of the disc specimens. Using confidence intervals (95%) for exact proportions and given 500 negatives, the chance the next occurrence would be positive would be 0.0060 or 0.60% or six of 1000. Conclusions. This study shows that if the symptoms, physical examination, radiographic diagnostic studies, and surgical findings are consistent with those of cervical disc herniation or spondylosis, the chance of an unexpected, clinically important pathologic finding within the disc specimen is extremely small. The time and expense involved in routine pathologic examination of cervical disc specimens can be avoided.

James Levine

Papers

Is pathology examination of disc specimens necessary after routine anterior cervical discectomy and fusion