Minimally invasive vs. open posterior lumbar fusion: 6 key notes on cost, quality


Ontario, Canada-based spine specialist Y. Raja Rampersaud, MD, along with his colleagues examined the economics of minimally invasive surgery for posterior lumbar fusion and presented their findings at the Society for Minimally Invasive Spine Surgery Forum 2014.

The study authors conducted a systematic review of several databases, including Medline and EMBASE, for studies where patients underwent minimally invasive or open spine surgery. Two independent assessors identified randomized controlled trials or comparative cohort studies for the analysis. The studies included 10 or more patients.


There were 26 articles that met inclusion criteria, but all studies were low or very low quality. There were 856 patients who underwent minimally invasive surgery and 806 patients who underwent open surgery. The researchers found:


1. Minimally invasive surgery led to 260 mL less blood loss.


2. Patients who underwent minimally invasive surgery were able to ambulate 3.5 days sooner and leave the hospital 2.9 days quicker than the open surgery patients.


3. There wasn't a significant difference in surgical time between the open and minimally invasive procedures.


4. The patients undergoing minimally invasive surgery were less likely to have medial adverse events, but there wasn't a difference in non-union or reoperation rates between the two groups.


5. At an average follow-up of two years after surgery, the Oswestry Disability Index scores were slightly better in the minimally invasive group than the open group.


6. Costs were lower for the minimally invasive surgery patients due to the shorter hospital stay.


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