Clinical radiology
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This pictorial essay reviews the normal appearances and the post-operative complications of intervertebral cages. These are implants which are being more widely used in spinal surgery. The text outlines the background leading to their development, the clinical indications and surgical techniques for insertion of the cages. The normal post-operative appearance of fusion and the complications that can occur are emphasized.
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Comparative Study
The cost effectiveness of metal oesophageal stenting in malignant disease compared with conventional therapy.
Expanding metal oesophageal stents are being used more commonly to palliate patients with inoperable oesophageal carcinoma. Many reports have so far documented their clinical effectiveness, however, their high acquisition cost has caused on-going concern when compared with the cost of conventional therapies. We reviewed 64 consecutive patients with inoperable oesophageal carcinoma, half of whom had received our conventional method of palliation using a variety of techniques including, BICAP diathermy, alcohol injection and Atkinson tube insertion. ⋯ However, once this was corrected for survival the difference in the cost of palliation on a per diem basis was reduced (metal stents = pound sterling 60 per day, conventional group = pound sterling 72 per day). The results of our study indicate that the initial high cost of metal stents is more than outweighed by resource savings elsewhere in the hospital by virtue of reduced need for re-intervention and shorter length of hospital in patient stay. Such cost savings taken in combination with the improved clinical effectiveness and low mortality related to metal stents provide significant support for introducing their use into clinical practice.