At What Surgical Cost Does Transforaminal Lumbar Interbody Fusion Becomes Less Cost-Effective Than Posterolateral Fusion for Spondylolisthesis?

Spine Universe—July 8, 2016

Reporter Kristin Della Volpe reports on a recent study published in JNS Spine that suggests that the cost of TLIF (transforaminal lumbar interbody fusion) per quality-adjusted life years vs. PSF (posterolateral fusion) in the treatment of spondylolisthesis depends on the measure of health utility selected, durability of the intervention, readmission rates and the accuracy of cost assumptions.

Russel C. Huang, MD, a spine surgeon at Hospital for Special Surgery, provides commentary: "The authors used propensity matching to best ensure that the two cohorts were as similar as possible, but the majority of surgeons are choosing PSF or TLIF based on patient characteristics (such as severity of foraminal collapse or presence of discogenic pain) that are not accounted for in the propensity matching process. This flaw in analysis would tend to underestimate the value of TLIF."

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