Cost-Effectiveness of Image-Guided Spine Surgery

Robert Green Watkins, IV*, 1 , Akash Gupta2, Robert Green Watkins, III1
1 Marina Spine Center, 13160 Mindanao Way, Suite 325, Marina del Rey, CA 90292, USA
2 Keck School of Medicine, University of Southern California, USA

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 1202
Abstract HTML Views: 457
PDF Downloads: 387
Total Views/Downloads: 2046
Unique Statistics:

Full-Text HTML Views: 690
Abstract HTML Views: 291
PDF Downloads: 300
Total Views/Downloads: 1281

Creative Commons License
© Watkins IV et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Marina Spine Center, 13160 Mindanao Way, Suite 325, Marina del Rey, CA 90292, USA; Tel: 310 448 7890; E-mail:



To determine if image-guided spine surgery is cost effective.


A prospective case series of the first 100 patients undergoing thoracolumbar pedicle screw instrumentation under image-guidance was compared to a retrospective control group of the last 100 patients who underwent screw placement prior to the use of image-guidance. The image-guidance system was NaviVision (Vector Vision-BrainLAB) and Arcadis Orbic (Siemens).


The rate of revision surgery was reduced from 3% to 0% with the use of image guidance (p=0.08). The cost savings of image guidance for the placement of pedicle screws was $71,286 per 100 cases. Time required for pedicle screw placement with image guidance was 20 minutes for 2 screws, 29 minutes for 4 screws, 38 minutes for 6 screws, and 50 min for 8 screws. Cost savings for the time required for placement of pedicle screws with image guidance can be estimated by subtracting the time required with currently used techniques without image guidance from the above averages, then multiplying by $93 per minute. The approximate costs of the navigation system is $475,000 ( $225,000 for Vector Vision-BrainLAB and $250,000 for Arcadis Orbic-Siemens).


Image guidance for the placement of pedicle screws may be cost effective in spine practices with heavy volume, that perform surgery in difficult cases, and that require long surgical times for the placement of pedicle screws.

Keywords: Cost, image-guidance, instrumentation, navigation, spine.