Lumbar spinal fusion versus anterior lumbar disc replacement: the financial implications.

STUDY DESIGN: Cost-identification analysis with retrospective and calculated cost.

OBJECTIVE: To determine the relative cost of lumbar spinal fusion versus anterior lumbar disc replacement.

SUMMARY OF BACKGROUND DATA: Although several methods of treatment for lumbar spinal degenerative disc disease are currently accepted, no single treatment has been proven superior. In the past, the standard treatment has been spinal fusion; however, fusion surgery has many short and long-term limitations. Lumbar disc replacement surgery is now Food and Drug Administration-approved and is an accepted treatment in well selected patients. Initial results showed its equivalence with fusion in 2-year outcome studies, and more recent data has even indicated a superiority. In the current healthcare system, cost of the treatment plays a major role in the availability and acceptance of medical therapies. To date, cost analysis information has not been available for disc replacement surgery relative to spinal fusion.

METHODS: A review of hospital costs was performed for 10 randomly selected patients in each group who underwent single-level lumbar transforaminal interbody fusion (TLIF), anterior and posterior spinal fusion (ASF/PSF), ASF alone, and anterior disc replacement. Additionally, the University Hospital Consortium database was queried for average cost per hospital day and average cost per operating room minute. These data were combined with ProDisc clinical IDE trial data to calculate the cost of each treatment.

RESULTS: The actual cost of implants at our institution for ASF/PSF, ASF, TLIF, and disc replacement were similar when rhBMP-2 was not included in the calculations. Total hospital costs for ASF/PSF were significantly higher than for TLIF, ASF, or disc replacement.

CONCLUSIONS: The hospital cost of disc replacement surgery is similar to TLIF and ASF (when rhBMP-2 cost is excluded) and is significantly less expensive than ASF/PSF.