Single Position Lumbar Spine Interbody Fusion and Pedicle Screw Placement Reduces Operating Room Costs

Retrospective cohort study.

To compare quality metrics and cost-effectiveness of single-position (SP) versus dual positioning (DP) approaches for lumbar interbody fusion (LLIF) or anterior lumbar interbody fusion (ALIF) with posterior pedicle screw fixation.

Spine surgeons are increasingly performing lumbar interbody fusions in the SP position to reduce intraoperative times and cost. However, the actual extent of cost savings associated with the SP within the US has yet to be elucidated.

Patients who underwent SP versus DP approaches for LLIF or ALIF at a single institution were identified. Cost data, demographics, complications, operative variables, and surgical details were compared between SP and DP cohorts. Univariate and multivariate analyses were performed to identify independent predictors for increased costs.

Thirty-six patients (60%) underwent DP, and 24 (40%) patients underwent SP. The SP group had decreased mean operative time (221±87 vs. 367±173 min; P<0.001) and length of stay (3.3±2.7 vs. 4.4±2.6 d; P=0.02) relative to the DP cohort while demonstrating comparable complication rates. Operating room costs ($9546±5673 vs. $13,349±7358; <0.001), variable costs ($28,852±17,741 vs. $35,038±17,456; P=0.007), and total costs ($38,379±24,790 vs. $48,378±28,053; P<0.001) were significantly lower in the SP group.

Our results suggest that SP surgery significantly reduces operative time, length of stay, and costs in comparison with traditional DP surgery without increasing complications. While individual surgeon preferences and unaccounted factors may impact cost variations, our study supports that SP surgery may present a cost-effective approach with a comparable safety profile.