Related Experiment Video
Updated: Oct 6, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
A Cost-Driver Analysis of Transforaminal Lumbar Interbody Fusions: A 10-Year Single-Center Analysis
Heili Truumees1, Minkyoung Yoo2, Richard E Nelson2
1Department of Orthopaedic Surgery, University of Utah.
Study Design:
Retrospective cohort.
Objective:
To analyze costs (reimbursements herein "cost") of transforaminal lumbar interbody fusions (TLIF) over a 10-year period at a single academic center.
Summary Of Background Data:
Lumbar fusions are responsible for some of the highest charges billed to payers.
Methods:
Three hundred seventy-six patients who underwent single-level TLIF between 2014 and 2024 were reviewed. Costs were obtained from the Value Driven Outcomes framework and stratified by category, including implants. Multivariable fixed-effects regression was used to identify independent predictors of total and implant costs, controlling for patient and procedural factors.
Results:
Implants accounted for the largest share of total TLIF cost, comprising 51% on average. Within implant costs, bone graft expenses were stable over time, with implant hardware accounting for most of the variability in cost. Expandable cages were associated with a 25% higher total cost (P=0.023) and a 42% higher implant cost (P=0.031) compared with static cages.
Conclusions:
The primary driver of total cost for single-level TLIF was implant type, with expandable cages costing significantly more than static. Given this finding, the choice of implant may be a viable target for price reduction and optimizing value. Further studies are warranted to determine the impact of cage type on other outcomes.
Level Of Evidence:
Level III.
