• Kevin Phan, Jarred A Hogan, and Ralph J Mobbs.
• Department of Neurosurgery, University of New South Wales, High Street, Randwick, NSW, Australia. kphan.vc@gmail.com.
• Eur Spine J. 2015 Nov 1; 24 (11): 2503-13.

PurposeTo assess the cost-utility and perioperative costs of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) versus open-TLIF for degenerative lumbar pathologies.MethodsRelevant articles were identified from six electronic databases. Predefined end points were extracted and meta-analysis conducted from the identified studies.ResultsFor each study, the direct hospital cost for MI-TLIF was found to be less than that of open-TLIF. When these outcomes were pooled, direct hospital costs were found to be significantly lower in the MI-TLIF group [weighted mean difference (WMD), -$2820; I (2) = 61 %; P < 0.00001]. MI-TLIF was also associated with shorter hospitalization (WMD, 0.99; 95 % CI -1.81, -0.17; I (2) = 96 %; P = 0.02), trend toward reduced complications (relative risk 0.53; 95 % CI 0.23, 1.06; I (2) = 0 %; P = 0.07), and reduced blood loss (WMD, -246.40 mL; I (2) = 98 %; P = 0.003), but was not associated with a significant difference in operation time (WMD, -67.05; 95 % CI -169.44, 35.35; I (2) = 100 %; P = 0.20).ConclusionsFrom the limited evidence, the available data suggest a trend of significantly reduced perioperative costs, length of stay, and blood loss for minimally invasive compared with open surgical approaches for TLIF. MI-TLIF may represent an opportunity for optimal utilization and allocation of health-care resources from both a hospital and societal perspective.

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