Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis: comparative effectiveness and cost-utility analysis

World Neurosurg. 2014 Jul-Aug;82(1-2):230-8. doi: 10.1016/j.wneu.2013.01.041. Epub 2013 Jan 12.


Background: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for lumbar spondylolisthesis allows for the surgical treatment of back/leg pain while minimizing tissue injury and accelerating the patient's recovery. Although previous results have shown shorter hospital stays and decreased intraoperative blood loss for MIS versus open TLIF, short- and long-term outcomes have been similar. Therefore, we performed comparative effectiveness and cost-utility analysis for MIS versus open TLIF.

Methods: A total of 100 patients (50 MIS, 50 open) undergoing TLIF for lumbar spondylolisthesis were prospectively studied. Back-related medical resource use, missed work, and quality-adjusted life years were assessed. Cost of in-patient care, direct cost (2-year resource use × unit costs based on Medicare national allowable payment amounts), and indirect cost (work-day losses × self-reported gross-of-tax wage rate) were recorded, and the incremental cost-effectiveness ratio was calculated.

Results: Length of hospitalization and time to return to work were less for MIS versus open TLIF (P = 0.006 and P = 0.03, respectively). MIS versus open TLIF demonstrated similar improvement in patient-reported outcomes assessed. MIS versus open TLIF was associated with a reduction in mean hospital cost of $1758, indirect cost of $8474, and total 2-year societal cost of $9295 (P = 0.03) but similar 2-year direct health care cost and quality-adjusted life years gained.

Conclusions: MIS TLIF resulted in reduced operative blood loss, hospital stay and 2-year cost, and accelerated return to work. Surgical morbidity, hospital readmission, 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 a societal and hospital perspective.

Keywords: Comparative effectiveness; Cost-utility; Spondylolisthesis; Transforaminal lumbar interbody fusion.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Loss, Surgical
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Female
  • Fluoroscopy
  • Hospital Costs
  • Humans
  • Length of Stay
  • Lumbar Vertebrae / surgery
  • Lumbosacral Region / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Narcotics / therapeutic use
  • Pain / drug therapy
  • Pain / etiology
  • Perioperative Care
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology
  • Quality-Adjusted Life Years
  • Return to Work
  • Spinal Fusion / methods*
  • Spondylolisthesis / complications
  • Spondylolisthesis / economics
  • Spondylolisthesis / surgery*
  • Treatment Outcome
  • Young Adult


  • Narcotics