Transforaminal interbody fusion versus anterior-posterior interbody fusionof the lumbar spine: A financial analysis

Lumbar interbody fusion can be performed anteriorly or posteriorly. An ante rior approach generally requires an access surgeon and often is combined wi th a posterior fusion. A traditional posterior interbody fusion can destabi lize the spinal motion segment and requires neural retraction. A new surgic al technique, a transforaminal lumbar interbody fusion (TLIF), was recently described. It requires minimal neural retraction, and the disk space is ex posed posterolaterally with removal of only one facet joint. This study com pares the cast of an anterior-posterior one-level lumbar fusion with the co st of the same procedure performed using the TLIF technique. Table 1 lists the specific demographics. A retrospective review of the hospital charges o f 80 patients undergoing interbody lumbar stabilization was conducted. The two groups consisted of 40 patients with an anterior-posterior fusion and 4 0 patients who were fused circumferentially using the TLIF technique. A cos t analysis with normalization of 1998 dollars between the two groups was pe rformed. The TLIF group had an average operative time of 213 minutes, compa red with 269 minutes for the anterior-posterior group. In addition, an aver age additional 38 minutes were required to turn the patient from the anteri or or posterior position. The average blood loss for the anterior-posterior procedure was 969 mL, compared with 489 mL for the TLIF group. Twenty-thre e of the anterior-posterior patients received an average of 2.2 units of bl ood and six of the TLIF patients received an average of 1.3 units. Use of t he surgical intensive care unit was much lower in the TLIF group (38 of 40 patients versus 2 of 40 patients). The average length of stay was 6.1 days for the anterior-posterior group compared with an average of 3.3 days for t he TLIF group. The average cost of the anterior-posterior patients was $49, 085, compared with $33,784 for the TLIF group. Cost analysis between the tw o groups show the TLIF patients had an average savings of approximately $15 ,000 per admission. This cost comparison was conducted only for the time of the operative procedure. No attempt was made to analyze rates of fusion be tween the two groups or ultimate clinic outcome. There were no major compli cations in either group, and no patient returned to surgery fur a lumbar sp inal problem at the authors' hospital within I year of the index procedure.