Financial analysis of circumferential fusion versus posterior-only with thoracic pedicle screw constructs for main thoracic idiopathic curves between 70° and 100°

Purpose: Reports on thoracic pedicle screw (TPS) constructs have demonstrated their safety and efficacy; however, concerns exist regarding their increased cost. This is a review of adolescents with main thoracic scoliosis surgically treated with anterior release and posterior fusion or posterior fusion only. The objectives were to compare the radiographic outcomes and financial data of two surgical treatments: anterior/posterior spinal fusion (APSF) versus posterior spinal fusion (PSF-TPS) alone with TPSs, in patients with large 70-100° main thoracic adolescent idiopathic scoliosis (AIS) curves. Methods: We identified 43 patients with main thoracic Lenke type 1-4 AIS curves between 70 and 100° who had been treated with either APSF or PSF-TPS. Results: Both groups had equivalent radiographic corrections postoperatively. The PSF-TPS group patients had higher implant charges, but the APSF group had higher surgeon procedural charges, operating room charges, anesthesia charges, and inpatient room charges. Total charges were $75,295 for the APSF group and $71,236 for the PSF-TPS group (P > 0.05). Analyses of two subgroups of the APSF group, anterior release via thoracotomy versus VATS and same-day versus staged surgeries, failed to change any of the above findings. Conclusion: Based on this financial analysis, there was no statistically significant differences between the APSF and PSF-TPS groups, with equivalent radiographic corrections.