Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2015; 6(2): 190-201
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.190
Economic impact of minimally invasive lumbar surgery
Christoph P Hofstetter, Anna S Hofer, Michael Y Wang
Christoph P Hofstetter, Department of Neurological Surgery, University of Washington, Seattle, WA 98105, United States
Anna S Hofer, Michael Y Wang, Department of Neurological Surgery, University of Miami MILLER School of Medicine, Miami, FL 33136, United States
Author contributions: All authors contributed to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Michael Y Wang, MD, Professor of Neurological Surgery, Orthopedics and Rehabilitation, University of Miami MILLER School of Medicine, 1475 NW 12th St, 1st Floor, Miami, FL 33136, United States.
Telephone: +1-305-2435081 Fax: +1-305-2433337
Received: May 29, 2014
Peer-review started: May 29, 2014
First decision: June 18, 2014
Revised: October 4, 2014
Accepted: October 14, 2014
Article in press: October 16, 2014
Published online: March 18, 2015

Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures.

Keywords: Value-based medicine, Cost efficiency, Minimally invasive spine surgery, Arthrodesis, Outcomes

Core tip: Minimally invasive lumbar microdiscectomy, decompression and short segment fixation result in clinical outcomes similar to traditional open surgery while decreasing the amount of blood loss, local tissue trauma, and length of hospitalization. Overall, there are few studies focusing on the economic impact of minimally invasive lumbar spine surgery. There is some evidence that minimally invasive short segment arthrodesis procedures are associated with higher cost effectiveness in acute perioperative period compared to traditional open surgery. Early results of minimally invasive surgical techniques for deformity correction appear promising, however, future studies need to address durability and cost effectiveness of these procedures.