Available online 12 January 2013
Publication year: 2013
Source:World Neurosurgery
Background Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for lumbar spondylolisthesis allows for surgical treatment of back/leg pain while minimizing tissue injury and accelerating recovery. Although prior results have shown shorter hospital stays and decreased intraoperative blood loss for MIS vs. open TLIF, short- and long-term outcomes have been similar. Therefore, we performed comparative effectiveness and cost-utility analysis for MIS vs. open TLIF. Methods 100 patients (50 MIS, 50 open) undergoing TLIF for lumbar spondylolisthesis were prospectively studied. Back-related medical resource utilization, missed work, and quality adjusted life years (QALYs) were assessed. Cost of in-patient care, direct cost (two-year resource use x unit costs based on Medicare national allowable payment amounts) and indirect cost (work-day losses x self-reported gross-of-tax wage rate) were recorded and incremental cost-effectiveness ratio was calculated. Results Length of hospitalization and time to return to work were less for MIS vs. open TLIF (p=0.006 and p=0.03, respectively). MIS vs. open TLIF demonstrated similar improvement in patient reported outcomes assessed. MIS vs. open TLIF was associated with reduction in mean hospital cost of $1,758, indirect cost of $8,474, and total two-year societal cost of $9,295 (p=0.03), but similar two-year direct healthcare cost and QALY-gained. Conclusions MIS TLIF resulted in reduced operative blood loss, hospital stay and two-year cost, and accelerated return to work. Surgical morbidity, hospital re-admission, and short- and long-term clinical effectiveness were similar between MIS and open TLIF. MIS TLIF may represent a valuable and cost saving advancement from the societal and hospital perspective.
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