Department of Orthopedic Surgery, University of California San Diego Medical Center, San Diego, CA, USA.
Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S375-82. doi: 10.1097/BRS.0b013e31820238d9.
Review of the literature.
To summarize current cost and clinical efficacy data in minimally invasive spine (MIS) surgery.
Cost effectiveness (CE), using cost per quality-adjusted life-years gained, has been shown for lumbar discectomy, decompressive laminectomy, and for instrumented and noninstrumented lumbar fusions in several high-quality studies using conventional, open surgical procedures. Currently, comparisons of costs and clinical outcomes of MIS surgery to open (or nonoperative) approaches are rare and of lesser quality, but suggest that a potential for cost benefits exist using less-invasive surgical approaches.
A literature review was performed using the database of the National Center for Biotechnology Information (NCBI), PUBMED/Medline.
Reports of clinical results of MIS approaches are far more common than economic evaluations. MIS techniques can be classified as endoscopic or nonendoscopic. Although endoscopic approaches decrease some approach morbidities, the high cost of instrumentation, steep learning curves, and new complication profiles introduced have prevented widespread adoption. Additionally, the high costs have not been shown to be justified by superior clinical benefits. Nonendoscopic MIS approaches, such as percutaneous posterior or lateral, and mini-open lateral and anterior approaches, use direct visualization, standard operative techniques, and report lower complication rates, reduced length of stay, and faster recovery time. For newer MIS and mini-open techniques, significantly lower acute and subacute costs were observed compared with open techniques, mainly due to lower rates of complications, shorter length of stay, and less blood loss, as well as fewer discharges to rehab. Although this suggests that certain MIS procedures produce early cost benefits, the quality of the existing data are low.
Although the CE of MIS surgery is yet to be carefully studied, the few economic studies that do exist suggest that MIS has the potential to be a cost-effective intervention, but only if improved clinical outcomes are maintained (durable). Longer follow-up and better outcome and cost data are needed to determine if incremental CE exists with MIS techniques, versus open or nonsurgical interventions.
文献回顾。
总结微创脊柱（MIS）手术的当前成本和临床疗效数据。
使用每获得一个质量调整生命年的成本（成本效益），已在几项高质量研究中显示出腰椎间盘切除术、减压性椎板切除术、以及使用常规开放性手术的器械性和非器械性腰椎融合术的成本效益。目前，MIS 手术与开放性（或非手术）方法的成本和临床结果比较很少且质量较低，但表明使用微创外科方法可能具有成本效益。
使用国家生物技术信息中心（NCBI）、PubMed/Medline 的数据库进行文献回顾。
MIS 方法的临床结果报告远比经济评估更常见。MIS 技术可分为内镜或非内镜。虽然内镜方法减少了一些入路的发病率，但器械成本高、陡峭的学习曲线以及引入的新并发症特征阻止了其广泛采用。此外，较高的成本并没有被证明是临床获益的合理依据。非内镜性微创方法，如经皮后路或外侧、微创侧方和前路，使用直接可视化、标准手术技术，报告较低的并发症发生率、较短的住院时间和更快的恢复时间。对于较新的 MIS 和微创技术，与开放性技术相比，观察到明显较低的急性和亚急性成本，主要是由于并发症发生率较低、住院时间较短、失血量较少，以及康复出院的人数较少。尽管这表明某些 MIS 手术具有早期的成本效益，但现有数据的质量较低。
尽管 MIS 手术的成本效益尚未得到仔细研究，但现有的少数经济研究表明，MIS 具有成为一种具有成本效益的干预措施的潜力，但前提是保持（持久）更好的临床结果。需要进行更长时间的随访和更好的结果和成本数据，以确定与开放性或非手术干预相比，MIS 技术是否存在增量成本效益。
