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CLINICAL PRACTICE
From the 1Department of Orthopaedics at the Hospital for Special Surgery in New York City, New York; 2Department of Orthopedics at the University of Tsukuba Hospital in Tsukuba, Japan; and 3 Weill Cornell Medical College in New York City, New York
Economics of Minimally Invasive Spine Surgery M i n i ma l ly i nv a sive su rger y Adrian T.H. Lui, MBBS (MIS) in spine care encompasses techniques that achieve the goals of traditional open surgery while reducing soft tissue disruption and preserving stabilizing structures.1,2 Utilization of MIS techniques has accelerated in recent years, supported by evidence of Nicholas J. Giattino, BA1 reduced perioperative morbidity, shorter hospitalizations, and faster recovery. 3,4 While these clinical advantages are important, the broader impact of MIS lies in its potential to reshape t he economics of spine care. Tomoyuki Asada, MD, PhD1,2 Spine care is facing increasing pressures around value-based ca re, cost conta in ment, a nd resou rce a l locat ion. 5 –7 T hus, beyond clinical effectiveness, it is essential to understand how MIS inf luences cost dr ivers, short- and long-term economic Sheeraz A. Qureshi, MD, MBA1,3 outcomes, and the overall value to patients, providers, and societ y. This review aims to examine the contemporary economic implications of MIS utilization in spine surgery. 1
Cost Drivers and Savings in MIS The costs of spine surgery can be highly variable, ranging from $8,286 to $120,394.8,9
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Vertebral Columns
The major drivers of cost include medical devices/implants, facility and operating room expenses, hospitalization, and surgeon compensation. 8–10 In more complex cases, which often involve a greater number of levels, longer operating times and more intensive postoperative care further increase costs. Complicat ions, such as infection or hardware-related sequelae, can compound these costs by requiring further treatments, readmission, or even reoperations.11 Additionally, indirect costs, such as those relating to extended postoperative care needs, rehabilitation, and loss of productivity, should be considered to comprehensively evaluate the economic costs of undergoing spine surgery. MIS has the potential to alter the cost profile of spine procedures substantially and in several important ways. By reducing the procedural invasiveness, MIS can decrease surgical morbidity and speed up recovery in the immediate postoperative period, which may translate into lower hospital care costs.12,13 Reduced length of stay (LOS) is consistently cited as one of the most significant cost savings associated with MIS, in addition to lowered use of narcotics and inpatient rehabilitation needs.14–16 Furthermore, smaller incisions decrease the risk of surgical site infections, while earlier and improved patient mobilization can reduce medical complications
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