Cost–utility of minimally invasive versus open transforaminal lumbar interbody fusion: systematic review and economic evaluation

Phan, Kevin; Hogan, Jarred; Mobbs, Ralph J.

doi:10.1007/s00586-015-4126-4

Cited by 39 publications

(29 citation statements)

References 31 publications

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“…Most comparative studies currently available are retrospective [7–10]. Wong et al [10] compared 144 MI TLIF with 54 standard TLIF patients and found statistically significant benefits for MI TLIF in operating room time, blood loss, primary infection rates, secondary medical complications, LOS, transfusion need, hospital costs, short-term and long-term pain outcomes, and short-term and long-term ODI scores.…”

Section: Discussionmentioning

confidence: 99%

Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

Șerban

Calina

Tender

2017

BioMed Research International

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Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. We enrolled patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Forty patients were enrolled in each group. The differences in mean operative time and estimated blood loss were not statistically significant between the two groups. The patients were discharged after surgery at 4.12 days for the S TLIF group and 1.92 days for the MI TLIF group. The ODI improvement was similar and statistically significant in both groups. The fusion was considered solid in 36 (90%) of patients at 1 year in both groups. In conclusion, the two techniques provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. This trial is registered with NCT03155789.

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Section: Discussionmentioning

confidence: 99%

Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

Șerban

Calina

Tender

2017

BioMed Research International

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“…The statistics have been described elsewhere. 20 – 25 Briefly, the mean difference (MD) and relative risk (RR) were used as a summary statistic. In the present study, both fixed- and random-effect models were tested.…”

Section: Methodsmentioning

confidence: 99%

Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis

Campbell

Mobbs

et al. 2017

Global Spine Journal

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Study Design:Systematic review and meta-analysis.Objective:Current surgical management of degenerative spondylolisthesis (DS) involves decompression of the spinal canal followed by fusion with or without interbody. The additional functional and operative benefits derived from interbody inclusion has yet to be thoroughly established with a number of recent studies producing conflicting results. Thus, we aim to compare the functional and operative outcomes after fusion against interbody fusion in the treatment of DS.Methods:This systematic review of the literature comparing posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) outcomes in the treatment of DS was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of 6 databases yielded 386 articles from database inception to July 2016, which were screening against established criteria for inclusion into this study.Results:A total of 6 studies, satisfied criteria and reported outcomes for 721 patients. Fusion alone was performed in 458 (63.5%) patients and interbody fusion was performed in 263 (36.5%) patients. Functional outcomes Oswestry Disability Index (P = .29) and visual analog scale (P = .13) were not statistically different between the 2 approaches. Furthermore, there was no significant inferiority between fusion alone and with interbody in terms of the operative outcomes of blood loss (P = .38), reoperation rate (P = .66), hospital stay (P = .96), complication rate (P = .78), or fusion rate (P = .15).Conclusions:There was no statistically significant difference in functional and operative outcomes following fusion alone versus with interbody. Additional subgroup analysis of intrinsic DS features in future large, prospective, randomized controlled trials will improve the validity of these findings.

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“…The number of patients with complications was 54 out of 455 (11.87%) in MIS TLIF versus 64 out of 446 (14.35%) in OPEN TLIF. 3 Costs: The direct hospital costs for each study were lower in MIS TLIF than in OPEN TLIF, associated with less blood loss, fewer days in the hospital, and fewer complications. 12 A financial analysis of the total direct hospital costs (blood, imaging, implant, drugs, physical/occupational or speech therapy, hospital stay) were lower in MIS TLIF than in OPEN TLIF, at USD 19,512 versus USD 23,550, respectively.…”

Section: Introductionmentioning

confidence: 98%

“…1 Since Harms and Rolinger first described the procedure in 1982, OPEN TLIF has allowed circumferential arthrodesis and restoration of disc height, with a fusion rate of 95%, and has been considered a safe and effective option for the past 30 years. 3,4 The TLIF OPEN surgical technique consists of a standard incision in the midline with subperiosteal exposure of the musculature, exposing the facet joint complex to the distal space that is being fused in its entirety. A unilateral facetectomy is performed with the placement of an interbody cage and bilateral fixation with transpedicle screws.…”

Section: Introductionmentioning

confidence: 99%

“…13 Exposure to radiation: Most studies report higher exposure to radiation in MIS TLIF, ranging from 45.3 to 106 seconds as compared to 24-39 seconds for OPEN TLIF. Another study showed a difference of 37 seconds longer in MIS TLIF than in the OPEN TLIF procedure, as well as an average of 17 3,10 One study reported a significant difference in exposure to radiation of 2.7cGy/cm 2 for MIS TLIF and 1.8cGy/cm 2 for OPEN TLIF. 8 In a meta-analysis, 8 cohort studies were identified with a total of 619 patients.…”

Section: Introductionmentioning

confidence: 99%

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Tlif-Mis vs Tlif-Open: Cost Evaluation

et al. 2018

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Objective: To evaluate the direct costs of transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery (MIS) or open technique (OPEN). Methods: The present study is descriptive and retrospective. Sixteen patients with degenerative spinal pathology operated on with the TLIF MIS technique and TLIF OPEN were included over a 13-month period. Days of hospital stay, blood loss, surgical time, medical care and costs were compared. Results: The mean number of days of hospital stay was 6.7 ± 4.3 days with TLIF MIS and 11.1 ± 6.5 days with TLIF OPEN. The blood loss was 307 ± 81.6 ml (range 200-400 ml) with TLIF MIS and 803 ± 701.3 ml (range 200-1800 ml) with TLIF OPEN. The surgical time was 320 ± 92.6 minutes (range 210-500 minutes) in TLIF MIS and 372 ± 95.2 minutes (280-540 minutes) in TLIF OPEN. Conclusions: The difference in surgical costs and time between the two procedures was not statistically significant. There was less bleeding during the TLIF-MIS surgery, as well as a correlation between shorter days of hospital stay proportional to bleeding and surgical time, which translates into a reduction in the cost of these items. Level of Evidence III; Analysis based on alternatives and limited costs.Keywords: Intervertebral disc degeneration; Spinal fusion; Arthrodesis. de 6,7 ± 4,3 días con TLIF MIS y de 11,1 ± 6,5 días con TLIF OPEN. La pérdida sanguínea fue de 307 ± 81, con TLIF MIS y de 803 ± 701,3 ml (rango 200-1800 ml) RESUMO Objetivo: Garantir benefícios econômicos diretos de cada procedimento cirúrgico. Metodologia: apresentar um estudo descritivo e retrospectivo. Dezesseis pacientes com patologia degenerativa de colônias operados com a técnica TLIF MIS e TLIF OPEN foram incluídos durante um período de 13 meses. Foram comparados os dias de internação RESUMEN Objetivo: Evaluar los costos directos de la fusión intersomática lumbar transforaminal (TLIF) de mínima invasión (MIS) o técnica abierta (OPEN). Métodos: El presente estudio es descriptivo y retrospectivo. Se incluyeron 16 pacientes con patología degenerativa de columna intervenidos con la técnica TLIF MIS y TLIF OPEN en un período de 13 meses. Se compararon días de estancia hospitalaria, pérdida sanguínea, tiempo quirúrgico, atención médica y costos. Resultados: La media de días de estancia hospitalaria fue

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Cost–utility of minimally invasive versus open transforaminal lumbar interbody fusion: systematic review and economic evaluation

Cited by 39 publications

References 31 publications

Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis

Tlif-Mis vs Tlif-Open: Cost Evaluation

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