Histopathological examination of intervertebral disc specimens: a cost-benefit analysis.
01 Nov 2007-Canadian Journal of Neurological Sciences (Cambridge University Press)-Vol. 34, Iss: 4, pp 451-455
TL;DR: In routine cases, histopathological examination of disc specimens is not justified, and the decision to send specimens for pathological examination should be based on the surgeon's judgment.
Abstract: But: Dans les hopitaux nord- americains, les specimens de disques intervertebraux sont examines de routine en anatomopathologie. Cependant, des etudes recentes ont remis en question la pertinence de cette pratique dans les cas ou l'indication chirurgicale est une pathologie benigne comme une maladie discale degenerative. Cette etude porte sur le ratio cout-benefice de cette pratique. Methodes : Nous avons effectue une analyse cout-benefice de l'examen anatomopathologique fait de routine entre 1996 et 2004 sur 1775 specimens provenant de discectomies faites de routine (indications chirurgicales non neoplasiques et non infectieuses) et 70 specimens provenant de discectomies chez des patients chez qui on soupconnait une neoplasie ou une infection. La revue des dossiers a permis de determiner si les constatations anatomopathologiques etaient significatives au point de vue clinique, c'est-a-dire si elles avaient influence le traitement du patient. Nous avons calcule le cout total. Une revue de la litterature nous a permis de comparer nos resultats a ceux d'autres chercheurs. Resultats : Nous avons decouvert 4 comptes rendus anatomopathologiques inattendus parmi les 1775 specimens provenant des cas de routine, dont un etait significatif au point de vue clinique, a un cout 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'etaient pas faites de routine, le cout par constatation anatomopathologique anormale etait de 116,67$. Conclusions : Quand il s'agit de cas de routine, l'examen anatomopathologique des specimens de disques n'est pas justifie. La decision de demander un examen anatomopathologique de ces specimens chirurgicaux devrait etre basee sur le jugement du chirurgien.
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TL;DR: The elimination of routine pathologic examination of surgical discectomy specimens would not have lowered the standard of care; the pathologist's report had no discernible influence on patient management.
Abstract: A retrospective review of 508 charts of patients undergoing laminectomy for all reasons was carried out with special attention to the preoperative diagnosis, postoperative diagnosis, pathologic diagnosis, and discharge diagnosis. The elimination of routine pathologic examination of surgical discectomy specimens would not have lowered the standard of care; the pathologist's report had no discernible influence on patient management. Unusual clinical features will continue to require careful examination of surgical specimens by the pathologist. Millions of healthcare dollars can be saved by eliminating this routine examination, which is based on outmoded routines. Hospital medical staffs who wish to change this practice must revise their hospital bylaws in keeping with the standards of the The Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
41 citations
"Histopathological examination of in..." refers background in this paper
...The following cases were excluded: (1) three specimens obtained during myelomeningocele or lipomeningocele repair; (2) three synovial cysts erroneously coded as disc material; (3) three reports in which no recognizable material for pathological examination was identified; (4) four specimens for which the indication for surgery was not available...
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TL;DR: Before definitive policy conclusions can be made, additional studies are needed to better define the trade-off between cost and the value of information and the incidence of detecting clinically significant disease.
Abstract: Although the histologic examination of routine tissues, such as hernia sacs and intervertebral disks, has shown a low incidence of detecting clinically significant unsuspected disease, the cost-effectiveness of histologic examination has not been determined. By using a theoretical model that assumed variable costs and gains in life expectancy secondary to detecting clinically significant disease, a threshold incidence of disease detection at which histologic examination is cost-effective was determined. By using the University of Iowa (Iowa City) cost of examination (approximately $25), at least I of every 2,000 examinations would have to show clinically significant disease for histologic examination to be cost-effective. This threshold incidence decreases as production costs decrease or life-year values increase. Before definitive policy conclusions can be made, additional studies are needed to better define the trade-off between cost and the value of information and the incidence of detecting clinically significant disease.
38 citations
TL;DR: Pathological study of intervertebral disc specimens is cost beneficial only in cases with significant preoperative clinical diagnoses, and routine evaluation of routine herniated nucleus pulposus extracted during decompressive surgeries is not warranted.
19 citations
TL;DR: Histological examination of intervertebral disc specimens is cost beneficial only if there is a significant preoperative clinical diagnosis, and no cost-benefit analysis of this practice was made.
Abstract: 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...
19 citations
"Histopathological examination of in..." refers background in this paper
...The following cases were excluded: (1) three specimens obtained during myelomeningocele or lipomeningocele repair; (2) three synovial cysts erroneously coded as disc material; (3) three reports in which no recognizable material for pathological examination was identified; (4) four specimens for which the indication for surgery was not available...
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TL;DR: 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.
Abstract: 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.
16 citations
"Histopathological examination of in..." refers background in this paper
...The following cases were excluded: (1) three specimens obtained during myelomeningocele or lipomeningocele repair; (2) three synovial cysts erroneously coded as disc material; (3) three reports in which no recognizable material for pathological examination was identified; (4) four specimens for which the indication for surgery was not available...
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