Comparative Cost Analysis: Uniportal Endoscopy, Biportal Endoscopy, Microtubular, and Open Spine Surgery [Retrospective Review].

STUDY

DESIGN

A retrospective review.

OBJECTIVE

To perform a comparative cost analysis of unilateral biportal endoscopic surgery (UBE), uniportal endoscopic surgery, microtubular surgery, and open surgery in outpatient and inpatient settings.

SUMMARY OF BACKGROUND DATA: Endoscopic spine surgery techniques have gained traction for their benefits. However, the relative costs of biportal and uniportal endoscopic approaches compared with traditional methods, such as microtubular and open spine surgery, remains a debated topic. An evaluation of cost implications is critical for health care providers and policymakers when considering the most economical and effective surgical options for patients requiring spine surgery.

METHODS

The surgical logs of 2 spine surgeons were analyzed to identify patients who underwent primary, single-level lumbar discectomy utilizing biportal endoscopic lumbar microdiscectomy, uniportal endoscopic lumbar microdiscectomy, tubular lumbar microdiscectomy, or open lumbar microdiscectomy between January 2022 and March 2024. For each case, a specified list of medications, surgical supplies, and labor costs was obtained and analyzed.

RESULTS

In total, 195 surgeries were chosen for cost analysis with 88 patients in Group A, 61 patients in Group B, 41 patients in Group C, and 5 patients in Group D. Using tubular surgery as the baseline, uniportal endoscopic surgery (Group D) was the most expensive, with nearly 2.5× the cost of tubular surgery across settings. Biportal endoscopic surgery (Group A) had costs spanning from 1.14 to 1.6, with a group mean of 1.23, making it more costly than both tubular (Group B) and open surgery (Group C). Open surgery had slightly greater costs than tubular, with a group average of 1.09. Relative costs were consistent across settings.

CONCLUSIONS

Uniportal endoscopic surgery was determined to have significantly higher costs. UBE had moderately higher costs but remained the more economical endoscopic approach.