Cost-Effectiveness of Minimal Access Versus Conventional Spine Surgery

Surgical techniques for the cervical and lumbar spine can be separated into two categories based on amount of tissue disruption. Minimal access surgery (MAS) is reported to have better short term perioperative results as it utilizes small incisions and minimal muscle disruption. This technique involves use of a tube or sleeve to complete a muscle dilating or muscle splitting approach. Conventional surgery or open spine surgery involves lifting or stripping the musculature along the spine to gain access to the spine.

Patients undergoing minimal access cervical or lumbar surgery report less blood loss, lower chance of infection shorter hospital stays and less pain medication and often a faster return to activity. Long term outcomes of a minimal access surgery are not significantly different from a conventional approach that may involve less favorable short term benefits. On the surface, with results such as shorter hospital stays and a lower chance of infection, it would seem that minimal access surgery would be more cost effective. However, the instrumentation required for these techniques is often expensive and may outweigh the savings elsewhere.

A review of the current literature did not yield any results that compare the cost-effectiveness of minimal access spine surgery to conventional spine surgery for the cervical spine. There were six pertinent reports that met exclusionary criteria that were found comparing the two techniques for the lumbar spine. Surgical procedures in which the two techniques were compared include discectomy, hemilaminectomy, transforaminal fusion, and posterolateral fusion, all of the lumbar spine.

Results of the literature review using these six economic studies comparing MAS with conventional open spine surgery suggest that there is no economic difference between the two techniques. Complications post-surgery, particularly infection were reduced with MAS, and in at least one study they suggest that the minimal access surgery technique for fusion results in lower cumulative costs. Several other studies also suggested cost-saving with MMAS but were excluded from the review as they did not meet requirements of detailed methodology or long term follow up on clinical outcomes. There is a need for more detailed studies comparing cost-effectiveness of MAS to open conventional spine surgery in order to better understand these surgical approaches.