Unilateral Pedicle Screw Fixation is Associated with Reduced Cost and Similar Outcomes in Selected Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion for L4-5 Degenerative Spondylolisthesis.

Philip Eliades,Daniel B Herrick,Steven Hwang,Brian M Corliss,Jason P Rahal,James T Kryzanski,Ron Riesenburger

doi:10.7759/cureus.249

Abstract

Study design:Retrospective study of 24 patients who underwent either a bilateral or unilateral TLIF procedure for the treatment of degenerative spondylolisthesis. Objective:To analyze differences in cost and outcome between patients undergoing minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with unilateral or bilateral pedicle screw fixation for L4-5 degenerative spondylolisthesis.Summary of background data:Lumbar fusion surgeries, including the TLIF procedure, have been shown to be an effective treatment for leg and low back pain caused by degenerative spondylolisthesis. Some studies have shown TLIF surgeries to be cost-effective, but there is still a paucity of data and no consensus. Unilateral TLIFs can provide the same benefits as bilateral TLIFs, but come with additional benefits of a less invasive surgery. Methods:We retrospectively analyzed a consecutive series of patients with L4-5 degenerative stenosis and spondylolisthesis who either received a unilateral or bilateral mi-TLIF, paying particular attention to hospital cost and clinical outcome. Of the 33 patients eligible for analysis, we were able to obtain appropriate clinical and radiographic follow-up data on 24 patients (72.7%), 14 patients who underwent unilateral fixation, and 10 patients who underwent bilateral fixation.Results:The cohorts were similar with regard to age, comorbidities, and demographics. Most patients reported good or excellent results, and there were no significant differences between the cohorts with regard to clinical outcome. There was one interbody graft extrusion in the unilateral cohort that required explantation, but no other hardware failures. Hospital cost was significantly lower in the unilateral cohort, and hardware savings accounted for only part of the difference.Conclusion:Unilateral pedicle screw fixation is an acceptable surgical strategy in patients with stable L4-5 degenerative spondylolisthesis undergoing mi-TLIF. In our series, unilateral fixation led to significant hospital cost savings without compromising clinical or radiographic outcomes.

Highlights

Given the significant portion of United States healthcare spending currently utilized for spinal care and the impetus to contain cost, it is clear that cost-effectiveness of treatments will come under increasing scrutiny
Hospital cost was significantly lower in the unilateral cohort, and hardware savings accounted for only part of the difference
We retrospectively reviewed our database of patients undergoing minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) between 2008 and 2011

Summary

Introduction

Given the significant portion of United States healthcare spending currently utilized for spinal care and the impetus to contain cost, it is clear that cost-effectiveness of treatments will come under increasing scrutiny. In particular, have received much attention given their expense and strikingly increased utilization over the past two decades [12]. It has become clear that lumbar fusion is clinically effective for patients with common but disabling disorders, such as lumbar spinal stenosis with degenerative spondylolisthesis [3,4,5,6,7]. A significant proportion of the cost of lumbar fusion is due to hardware and graft expense; yet there is no consensus on the constructs necessary to achieve satisfactory results. It is worthwhile to explore cost reduction through simplifying fusion constructs as long as clinical outcomes are not affected

Methods

Results

Conclusion