Costs and Economic Implications

The era of value-based healthcare necessitates consideration of costs and quality of life outcomes in both medical and surgical interventions. Minimally invasive surgery (MIS) of the spine has become increasingly popular with potential advantages including low perioperative morbidity, shortened length of stay, and the possibility of lower cost care. However, most of the literature is of low-quality evidence or minimal relative to cost analyses, especially with regards to lateral MIS approaches. Of those studies examining costs, the MIS lateral approach known as extreme lateral interbody fusion (XLIF; Nuvasive, San Diego, CA), direct lumbar interbody fusion (DLIF), or lateral lumbar interbody fusion (LLIF) has been shown to achieve significant cost savings of around $2,500 in the perioperative period and $10,000–20,000 after 2 years (about 10 % savings for both time periods). The few studies on this topic, however, have been limited by varying methods for cost calculations, small sample sizes, or short follow-up, making it difficult to draw conclusions. Future studies are necessary to further evaluate the cost-effectiveness of MIS lateral approaches to the spine.