Use of Local Morselized Bone Autograft in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Cost Analysis

World Neurosurg. 2021 Feb:146:e544-e554. doi: 10.1016/j.wneu.2020.10.126. Epub 2020 Oct 28.


Objective: Few studies have investigated the financial influence of surgical site local morselized bone autograft (LMBA) on the overall cost of spinal arthrodesis procedures. The purpose of this study is to evaluate the potential savings from introducing LMBA in spinal fusion procedures compared with no LMBA use.

Methods: Retrospectively, cost analysis was conducted on a single-center data collected from 266 patients who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) ranging from L1 through S1 during a period of approximately 4 years. Cost data were obtained from individual patient invoices from the distributor. Sensitivity analyses were also conducted for different costs of allograft and LMBA.

Results: A total of 282 levels were grafted in 266 subjects. The total quantity of LMBA harvested was 2433.5 mL, and a total of 1610 mL of allograft (Trinity Elite, ORTHOFIX, Lewisville, Texas, USA) were used. The overall cost savings from introducing LMBA in MI-TLIF surgery were $1,094,931 over the 4-year period with mean direct cost saving of $4116.28 per patient based on reduction in allograft. Results for cost savings per patient were sensitive to different direct costs of allograft and LMBA. A >95% fusion rate was achieved based on dynamic radiographs evaluated by an independent radiologist.

Conclusions: LMBA is a cost-saving bone graft extender option in MI-TLIF procedures while achieving high fusion rates. The savings are mainly achieved by reducing the amount of allograft needed and subsequent reduction in the total bone graft costs. Further research needs to be performed regarding long-term economic benefit.

Keywords: Cost analysis; Cost effectiveness; Local morselized bone autograft; Minimally invasive; Savings; Transforaminal lumbar interbody fusion.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Autografts / economics*
  • Bone Transplantation / economics*
  • Bone Transplantation / methods
  • Costs and Cost Analysis*
  • Female
  • Humans
  • Intervertebral Disc Degeneration / surgery
  • Lumbar Vertebrae / surgery*
  • Lumbosacral Region / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / economics*
  • Minimally Invasive Surgical Procedures / methods
  • Postoperative Complications / surgery
  • Radiography / economics
  • Spinal Fusion / economics
  • Spinal Fusion / methods
  • Young Adult