OBJECTIVES: Minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion is used to treat lumbar degenerative disc disease (DDD). MIS has been acknowledged to reduce the probability of perioperative muscular damage compared to the traditional open surgery (OS) approach, however MIS requires a steep learning curve due to its technical complexity. Recently a novel gMIS/TLIF technique has been developed to simplify the procedure and improve clinical outcomes using a streamlined approach which eliminates the need for Jamshidi and guidewire techniques used in previous MIS. To inform evolving treatment practices this study compares estimated costs and outcomes of the gMIS/TLIF technique with existing MIS and OS approaches.

METHODS: A deterministic Excel model was developed to estimate direct costs of the different alternatives for treating DDD in the United Kingdom (UK). The model was populated with cost and clinical inputs from published studies and UK reference cost databases, including: resources used for each alternative, theatre time, imaging procedures, pharmaceuticals consumed, and hospitalization days. Treatment costs were adjusted to the base year 2017.

RESULTS: After factoring in additional costs associated with gMIS/TLIF, an overall cost savings of £2,790.24 per case was estimated compared with OS that was mostly attributed to reduced surgical time (£1,586.46) and hospitalization costs (£1,335.60). When compared to MIS, a reduction in the number of instruments needed and the number of instrument passes can result in shorter operation times for gMIS/TLIF, with an estimated cost savings of £1,606.58 per case.

CONCLUSIONS: The gMIS/TLIF approach offers a less invasive alternative for treating DDD that may limit soft-tissue damage and benefit health systems that may save costs. However, further study is required to fully interrogate its clinical benefits.