title: Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis grades 1-2: patient-reported clinical outcomes and cost-utility analysis.
abstract: BACKGROUND
  Transforaminal lumbar interbody fusion (TLIF) is the standard surgical treatment for patients with lumbar degenerative spondylolisthesis who do not respond to a 6-week course of conservative therapy. A number of morbidities are associated with the conventional open-TLIF method, so minimally invasive surgery (MIS) techniques for TLIF (MIS-TLIF) have been introduced to reduce the trauma to paraspinal muscles and hasten postoperative recovery. Because providing cost-effective medical treatment is a core initiative of healthcare reforms, a comparison of open-TLIF and MIS-TLIF must include a cost-utility analysis in addition to an analysis of clinical effectiveness.
  
  
  METHODS
  We compared patient-reported clinical functional outcomes and hospital direct costs in age-matched patients treated surgically with either open-TLIF or MIS-TLIF. Patients were followed for at least 1 year, and patient scores on the Oswestry Disability Index (ODI) and visual analog scale (VAS) were analyzed at 6 weeks, 6 months, and ≥1 year postoperatively in the 2 treatment groups.
  
  
  RESULTS
  Compared to their preoperative scores, patients in both the open-TLIF and MIS-TLIF groups had significant improvements in the ODI and VAS scores at each follow-up point, but no significant difference in functional outcome occurred between the open-TLIF and MIS-TLIF groups (P=0.46). However, open-TLIF is significantly more costly compared to MIS-TLIF (P=0.0002).
  
  
  CONCLUSIONS
  MIS-TLIF is a more cost-effective treatment than open-TLIF for patients with degenerative spondylolisthesis and is equally effective as the conventional open-TLIF procedure, although further financial analysis-including an analysis of indirect costs-is needed to better understand the full benefit of MIS-TLIF.
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Wale A R
authors.initials: WA
authors.lastname: Sulaiman
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Manish
authors.initials: M
authors.lastname: Singh
keywords: Costs and cost analysis; outcome assessment; pain measurement; spinal fusion; spinal instrumentation; spondylolisthesis; surgical procedures–minimally invasive