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Minimally invasive surgery has benefits over open surgery for lumbar decompression and/or fusion but there is no established consensus regarding its cost effectiveness. Method A systematic electronic search of databases (MEDLINE, EMBASE and Cochrane Library) and manual search from the Cost Effectiveness Analysis (CEA) database and NHS Economic Evaluation Database (NHS EED). Two authors reviewed abstracts against exclusion criteria. Studies including adult populations undergoing surgery for degenerative changes (lumbar stenosis, lumbar radiculopathy, spondylolisthesis) of the lumbar spine, reporting outcomes of costing analysis, CEA or Incremental cost effectiveness ratio (ICER) were included. Results Two of the 5 studies comparing open vs single level MIS fusion surgery (TLIF) reported a statistically significant reduction in direct cost for MIS compared to open surgery. The mean non-inflation adjusted cost was $31,626, and $34757 for the MIS and open TLIF groups respectively. One paper comparing open versus MIS two level TLIF reported a statistically significant difference in costing but not in QALYs. Conclusions Generally, studies reported a reduced cost associated with MIS versus open surgery. One study reported a statistically significant change in QALY. The majority had a high risk of bias. This review was unable to recommend MIS over open surgery from a cost effectiveness perspective.

175 Open vs MIS Lumbar Surgery: A Systematic Review of Cost Effectiveness