Clinical spine surgery · 2026
A Cost-Driver Analysis of Transforaminal Lumbar Interbody Fusions: A 10-Year Single-Center Analysis.
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Truumees Heili, Yoo Minkyoung, Nelson Richard E, Baker Emma, Karamian Brian A
Аннотация
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.
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.