Introduction Lateral access surgery has seen an increase in popularity among spine surgeons since its initial introduction (1-3). The transpsoas approach provides access to the lumbar spine with relatively predictable anatomy and obviates the need for an access surgeon (4,5). Lateral access surgery is performed in the lateral decubitus position and the discectomy, endplate preparation, and interbody insertion are all performed while the patient remains in the lateral position. Once the interbody has been inserted, traditionally, the wounds are closed and the patient is repositioned prone for pedicle screw fixation (1). The repositioning requires completing a second round of prepping, draping, and room positioning, which may add significant time to the case and increase the risk of contamination. The lateral position tends to be better tolerated by the patient compared to prone surgery and avoids many of the major concerns that exist with prone positioning including but not limited to: postoperative vision loss, cardiovascular complications, hypovolemia, reduced pulmonary compliance, and cardiac arrest (6-8). Concern exists

3.

No abstract

Study Design. Retrospective database review. Objective. Compare 1-year episode of care costs between single-level decompression and decompression plus fusion for lumbar stenosis. Summary of Background Data. Lumbar stenosis is the most common indication for surgery in patients over 65. Medicare direct hospital costs for lumbar surgery reached $1.65 billion in 2007. Despite stenosis being a common indication for surgery, there is debate as to the preferred surgical treatment. Cost-minimization analysis is a framework that identifies potential cost savings between treatment options that have similar outcomes. We performed a cost-minimization analysis of decompression versus decompression with fusion for lumbar stenosis from the payer perspective. Methods. An administrative claims database of privately insured patients (Humana) identified patients who underwent decompression (n = 5349) or decompression with fusion (n = 8540) for lumbar stenosis with and without spondylolisthesis and compared overall costs. All patients were identified and costs identified for a 1-year period. Complication rates and costs were described using summary statistics. Results. Mean treatment costs at 1 year after surgery were higher for patients who underwent decompression and fusion compared to patients who underwent decompression alone ($20,892 for fusion vs. $6329 for decompression; P < 0.001). Facility costs (P < 0.001), surgeon costs (P < 0.001), and physical therapy costs (P < 0.001) were higher in the fusion group. Cost differences related to infection or durotomy reached significance (P < 0.04). No difference in cost was identified for supplies. Conclusion. Decompression had significantly lower costs for the treatment of lumbar stenosis, including treatment for postoperative complications. If cost minimization is the primary goal, decompression is favored for surgical treatment of lumbar stenosis. Other factors including shared decision-making directed toward patient's values, patient-reported outcomes, and preferences should also be recognized as drivers of healthcare decisions. Level of Evidence: 3