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The following paper provides an overview of refinancing of the services of Austrian healthcare institutions. Following an introduction to service-oriented healthcare institution financing of Austria, the example of radio-frequency kyphoplasty (DFine Europe GmbH) is used to illustrate its application to individual cases as an example. This procedure is particularly suitable since the augmentation of vertebral bodies has meanwhile become a standardized procedure and net benefits have been proven [1-4]. On the other hand, the procedure is innovative and improves on both clinical [5] and economic [6] constraints of conventional kyphoplasty procedures. It is furthermore possible to simulate various scenarios for added payments and deductions and outline the effects of added services without constructing complex clinical processes. Finally, there is a critical consideration of the illustration of radio-frequency kyphoplasty in the service-oriented hospital financing system, also against the background of guidance in healthcare policy.


Kruger A.,University of Marburg | Oberkircher L.,University of Marburg | Kratz M.,University of Marburg | Baroud G.,Université de Sherbrooke | And 2 more authors.
International Journal of Spine Surgery | Year: 2012

Background: The treatment of painful osteoporotic vertebral compression fractures with transpedicular cement augmentation has grown significantly over the last 20 years. There is still uncertainty about long-term and midterm effects of polymethyl methacrylate in trabecular bone. Preservation of the trabecular structures, as well as interdigitation of the cement with the surrounding bone, therefore has been gaining increasing attention. Interdigitation of cement is likely relevant for biological healing and the biomechanical augmentation process. In this study a cutting and grinding technique was used to evaluate the interdigitation for 4 augmentation techniques. Methods: By use of a standardized protocol, wedge fractures were created in vertebrae taken from a fresh-frozen spine. Thereafter the vertebrae were assigned to 1 of 4 similar groups with regard to the vertebral size and force required to produce the fracture. The 4 groups were randomized to the following augmentation techniques: balloon kyphoplasty, radiofrequency (RF) kyphoplasty, shield kyphoplasty, and vertebral stenting. Histologic analysis was designed to examine the bone structure and interdigitation after the augmentation. Results: For the void-creating procedures, the distance between bone and cement was 341.4 ± 173.7 μm and 413.6 ± 167.6 μm for vertebral stenting and balloon kyphoplasty, respectively. Specifically, the trabecular bone was condensed around the cement, forming a shield of condensed bone. The procedures without a balloon resulted in shorter distances of 151.2 ± 111.4 μm and 228.1 ± 183.6 μm for RF and shield kyphoplasty, respectively. The difference among the groups was highly significant (P < .0001). The percentage of interdigitation was higher for the procedures that did not use a balloon: 16.7% ± 9.7% for balloon kyphoplasty, 20.5% ± 12.9% for vertebral stenting, 66.45% ± 12.35% for RF kyphoplasty, and 48.61% ± 20.56% for shield kyphoplasty. The difference among the groups was highly significant (P < .00001). Conclusions: Cavity-creating procedures reduce the cement interdigitation significantly and may accordingly reduce the effectiveness of the augmentation procedures. © 2012 Elsevier Inc.


PubMed | University of Marburg, Université de Sherbrooke and Institute for Musculoskeletal Analysis
Type: | Journal: International journal of spine surgery | Year: 2015

The treatment of painful osteoporotic vertebral compression fractures with transpedicular cement augmentation has grown significantly over the last 20 years. There is still uncertainty about long-term and midterm effects of polymethyl methacrylate in trabecular bone. Preservation of the trabecular structures, as well as interdigitation of the cement with the surrounding bone, therefore has been gaining increasing attention. Interdigitation of cement is likely relevant for biological healing and the biomechanical augmentation process. In this study a cutting and grinding technique was used to evaluate the interdigitation for 4 augmentation techniques.By use of a standardized protocol, wedge fractures were created in vertebrae taken from a fresh-frozen spine. Thereafter the vertebrae were assigned to 1 of 4 similar groups with regard to the vertebral size and force required to produce the fracture. The 4 groups were randomized to the following augmentation techniques: balloon kyphoplasty, radiofrequency (RF) kyphoplasty, shield kyphoplasty, and vertebral stenting. Histologic analysis was designed to examine the bone structure and interdigitation after the augmentation.For the void-creating procedures, the distance between bone and cement was 341.4 173.7 m and 413.6 167.6 m for vertebral stenting and balloon kyphoplasty, respectively. Specifically, the trabecular bone was condensed around the cement, forming a shield of condensed bone. The procedures without a balloon resulted in shorter distances of 151.2 111.4 m and 228.1 183.6 m for RF and shield kyphoplasty, respectively. The difference among the groups was highly significant (P < .0001). The percentage of interdigitation was higher for the procedures that did not use a balloon: 16.7% 9.7% for balloon kyphoplasty, 20.5% 12.9% for vertebral stenting, 66.45% 12.35% for RF kyphoplasty, and 48.61% 20.56% for shield kyphoplasty. The difference among the groups was highly significant (P < .00001).Cavity-creating procedures reduce the cement interdigitation significantly and may accordingly reduce the effectiveness of the augmentation procedures.


Becker S.,Institute for Musculoskeletal Analysis | Pfeiffer K.P.,Innsbruck Medical University | Ogon M.,Orthopaedic Hospital Vienna
European Spine Journal | Year: 2011

We performed an analysis of following costs after primary conservative or operative treatment with balloon kyphoplasty (BKP) in osteoporotic vertebral fractures. Patients with primary osteoporotic vertebral fractures treated with BKP or conservatively from discharge year 2002-2005 were retrospectively assessed regarding the following hospital treatment in any hospital in Austria from 2002 to 2006. A statistical record linkage between the hospital data and the mortality registry of Statistic Austria was performed. The data search was restricted to ICD-10 and procedures according to the Austrian catalogue of procedures defined as "spine relevant". Number of readmissions, length of hospital stay and DRG related costs were calculated for the surgical and conservative group separately. 324.5 years (mean 2.93 ± 1.40, conservative group) and 343.6 (mean 2.56 ± 0.96, BKP group) of 110 conservative patients and 134 BKP patients were analyzed. There was no statistical difference of the mortality rate with 9 patients (6.7%, BKP) and 11 patients (9.9%, conservative). The number of readmissions was 1.62 times higher (P = 0.039), the length of stay 1.09 times higher (P = 0.046) in the conservative group. No difference in the DRG scores were found (P = 0.11). In conclusion, patients with osteoporotic vertebral fractures showed in the following years after BKP fewer hospital readmissions and shorter hospital stays but no difference in DRG scores in comparison to conservatively treated patients. © Springer-Verlag 2011.


Becker S.,Institute for Musculoskeletal Analysis | Capobianco R.,Si Bone Inc. | Seita M.,Palma Clinic
European Journal of Orthopaedic Surgery and Traumatology | Year: 2015

Background context: Disorders of the sacroiliac joint are challenging to diagnose. This is partially due to similarity in symptom presentation to other lumbar spinal disorders and poor visibility of the joint on imaging studies. The pubic symphysis is clearly visualized in the anteroposterior view on plain film radiographs. As a closed ring, changes in the anterior and posterior portion of the pelvis may be reciprocal. The purpose of this study was to assess the correlation between pubic symphyseal changes observed on X-ray and SI joint disorders. Methods: Thirty patients with a confirmed diagnosis of SI joint disorders were compared with 30 patients with low back pain without the evidence of SI joint involvement. Plain film radiographs were blinded and independently reviewed by two orthopedic surgeons. Changes in the pubic symphysis were classified as (0) no change, (1) osteoarthritic degeneration, (2) vertical displacement, or (3) ligament ossification. Results: There was no significant difference between groups in age, gender, or parturition status. The majority of both groups were female. Mean (±SD) subject age was 61 (±11) and 59 (±9) years, and parity was 44 % and 39 % for the study and control groups, respectively. The prevalence of observable changes in the pubic symphysis was 97 % in the study group and 30 % in the control group (p < 0.001). Conclusion: Results of this study suggest that pubic symphyseal changes in the presence of low back pain and positive provocative maneuvers could serve as a marker for SI joint disease. Further investigation of the potential relationship between SI joint symptoms and symphyseal changes should be examined. © 2014, Springer-Verlag France.


Schwesig R.,Martin Luther University of Halle Wittenberg | Becker S.,Institute for Musculoskeletal Analysis | Fischer D.,Martin Luther University of Halle Wittenberg
Somatosensory and Motor Research | Year: 2014

Reliability of posturography is essential for the identification of intervention effects in any setting (e.g., sport, rehabilitation). The purpose was to establish the intraobserver reliability of a posturographic method in asymptomatic subjects (n=30). Intraclass correlation coefficients (relative reliability) for every parameter and all test positions (ALLmean) ranged from 0.78 (95% CI: 0.53-0.90) to 0.95 (95% CI: 0.89-0.97). Absolute reliability, quantified by using the coefficient of variation, ranged between 3.5 and 19.8. Reliability of single test positions is much lower. The posturographic system showed good relative and satisfactory absolute intraobserver reliability for ALLmean. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.


PubMed | Institute for Musculoskeletal Analysis
Type: | Journal: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie | Year: 2015

Disorders of the sacroiliac joint are challenging to diagnose. This is partially due to similarity in symptom presentation to other lumbar spinal disorders and poor visibility of the joint on imaging studies. The pubic symphysis is clearly visualized in the anteroposterior view on plain film radiographs. As a closed ring, changes in the anterior and posterior portion of the pelvis may be reciprocal. The purpose of this study was to assess the correlation between pubic symphyseal changes observed on X-ray and SI joint disorders.Thirty patients with a confirmed diagnosis of SI joint disorders were compared with 30 patients with low back pain without the evidence of SI joint involvement. Plain film radiographs were blinded and independently reviewed by two orthopedic surgeons. Changes in the pubic symphysis were classified as (0) no change, (1) osteoarthritic degeneration, (2) vertical displacement, or (3) ligament ossification.There was no significant difference between groups in age, gender, or parturition status. The majority of both groups were female. Mean (SD) subject age was 61 (11) and 59 (9) years, and parity was 44% and 39% for the study and control groups, respectively. The prevalence of observable changes in the pubic symphysis was 97% in the study group and 30% in the control group (p < 0.001).Results of this study suggest that pubic symphyseal changes in the presence of low back pain and positive provocative maneuvers could serve as a marker for SI joint disease. Further investigation of the potential relationship between SI joint symptoms and symphyseal changes should be examined.


PubMed | Institute for Musculoskeletal Analysis
Type: Comparative Study | Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2011

We performed an analysis of following costs after primary conservative or operative treatment with balloon kyphoplasty (BKP) in osteoporotic vertebral fractures. Patients with primary osteoporotic vertebral fractures treated with BKP or conservatively from discharge year 2002-2005 were retrospectively assessed regarding the following hospital treatment in any hospital in Austria from 2002 to 2006. A statistical record linkage between the hospital data and the mortality registry of Statistic Austria was performed. The data search was restricted to ICD-10 and procedures according to the Austrian catalogue of procedures defined as spine relevant. Number of readmissions, length of hospital stay and DRG related costs were calculated for the surgical and conservative group separately. 324.5years (mean 2.931.40, conservative group) and 343.6 (mean 2.560.96, BKP group) of 110 conservative patients and 134 BKP patients were analyzed. There was no statistical difference of the mortality rate with 9 patients (6.7%, BKP) and 11 patients (9.9%, conservative). The number of readmissions was 1.62 times higher (P=0.039), the length of stay 1.09 times higher (P=0.046) in the conservative group. No difference in the DRG scores were found (P=0.11). In conclusion, patients with osteoporotic vertebral fractures showed in the following years after BKP fewer hospital readmissions and shorter hospital stays but no difference in DRG scores in comparison to conservatively treated patients.


Schwesig R.,Martin Luther University of Halle Wittenberg | Fischer D.,Martin Luther University of Halle Wittenberg | Becker S.,Institute for Musculoskeletal Analysis | Leuchte S.,Martin Luther University of Halle Wittenberg
Clinical Rehabilitation | Year: 2013

Objective: To validate previously proposed findings and to develop an objective, feasible and efficient bifactorial (risk factors: gait impairment and balance disorders) fall risk assessment. Design: Prospective follow-up study Setting: Nursing homes (Halle/Saale, Germany). Subjects: One hundred and forty-six nursing home residents (aged 62-101 years) were recruited. Methods: Gait data were collected using a mobile inertial sensor-based system (RehaWatch). Postural regulation data were measured with the Interactive Balance System. Falls were recorded in standardized protocols over a follow-up period of 12 months. Main measures: Gait parameters (e.g. spatial-temporal parameters), posturographic parameters (e.g. postural subsystems), number of falls. Results: Seventeen (12%) of the participants had more than two falls per year. The predictive validity of the previously selected posturographic parameters was inadequate (sensitivity: 47%). The new measurement tool defined 67 participants showing an increased risk of falls. In reality, only 8 participants actually fell more than twice during the follow-up period (positive predictive value (PPV): 12%). The negative predictive value (NPV) was 88%. The posturographic frequency range F2-4 (peripheral-vestibular system), stride time and standard deviation of landing phase were the most powerful parameters for fall prediction. Gait and postural variability were larger in the high-risk group (e.g. gait speed; confidence interval (CI)high: 0.57-0.79 vs. CIlow: 0.72-0.81 m/s). Conclusion: RehaWatch and the Interactive Balance System are able to measure two of the most important fall risk factors, but their current predictive ability is not satisfactory yet. The correlation with physiological mechanisms is only shown by the Interactive Balance System. © 2012 The Author(s).


Schwesig R.,Martin Luther University of Halle Wittenberg | Fischer D.,Martin Luther University of Halle Wittenberg | Becker S.,Institute for Musculoskeletal Analysis
Somatosensory and Motor Research | Year: 2014

The aim of the study was to establish the intraobserver reliability of a posturographic method in patients (n;=34) with vestibular neuritis. Intraclass correlation coefficients (relative reliability) for all parameters and test positions (ALLmean) ranged from 0.71 (95% CI: 0.41-0.85) to 0.92 (95% CI: 0.84-0.96). Absolute reliability (coefficient of variation) ranged between 3.1% (95% CI: 2.60-8.67) and 42.3% (95% CI: 40.7-74.5). Reliability of single test positions is much lower. The posturographic system showed good relative and satisfactory absolute intraobserver reliability for ALLmean. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.

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