Eseonu Kelechi, Oduoza Uche, Monem Mohamed, Tahir Mohamed
Royal National Orthopaedic Hospital Stanmore, Stanmore, London, UK
Royal National Orthopaedic Hospital Stanmore, Stanmore, London, UK.
Int J Spine Surg. 2022 Jul 14;16(4):612-24. doi: 10.14444/8297.
Minimally invasive surgery (MIS) has benefits over open surgery for lumbar decompression and/or fusion. Published literature on its cost-effectiveness vs open techniques is mixed.
Systematically review the cost-effectiveness of minimally invasive vs open lumbar spinal surgical decompression, fusion, or discectomy using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
A systematic electronic search of databases (MEDLINE, Embase, and Cochrane Library) and a manual search from the cost-effectiveness analysis (CEA) database and National Health Service economic evaluation database was conducted. Studies that included adult populations undergoing surgery for degenerative changes in the lumbar spine (stenosis, radiculopathy, and spondylolisthesis) and reported outcomes of costing analysis, CEA, or incremental cost-effectiveness ratio were included.
A total of 17 studies were included. Three studies assessed outcomes of MIS vs open discectomy. All 3 reported statistically significant lower total costs in the MIS, compared with the open group, with similar reported gains in quality-adjusted life years (QALYs). Two studies reported cost differences in MIS vs open laminectomy, with significantly lower total costs attributed to the MIS group. Twelve studies reported findings on the relative direct costs of MIS vs open lumbar fusion. Among those, 3 of the 4 studies comparing single-level MIS-transforaminal lumbar interbody fusion (TLIF) and open TLIF reported lower total costs associated with MIS procedures. Six studies reported cost evaluation of single- and 2-level TLIF procedures. Lower total costs were found in the MIS group compared with the open fusion group in all studies except for the subgroup analysis of 2-level fusions in a single study. Three of these 6 studies reported cost-effectiveness (cost/QALY). MIS fusion was found to be more cost-effective than open fusion in all 3 studies.
The studies reviewed were of poor to moderate methodological quality. Generally, studies reported a reduced cost associated with MIS vs open surgery and suggested better cost-effectiveness, particularly in MIS vs open single- and 2-level TLIF procedure. Most studies had a high risk of bias. Therefore, this review was unable to conclusively recommend MIS over open surgery from a cost-effectiveness perspective.
The incidence of spinal decompressive and fusion surgey and financial constraints on healthcare services continue to increase. This study aims to identify the cost and clinical effectiveness of common approaches to spinal surgery.
3a.
在腰椎减压和/或融合手术中，微创手术（MIS）比开放手术更具优势。关于其与开放技术相比的成本效益的已发表文献参差不齐。
使用系统评价和Meta分析的首选报告项目指南，系统评价微创与开放腰椎手术减压、融合或椎间盘切除术的成本效益。
对数据库（MEDLINE、Embase和Cochrane图书馆）进行系统的电子检索，并从成本效益分析（CEA）数据库和国家卫生服务经济评价数据库进行人工检索。纳入的研究包括接受腰椎退行性变（狭窄、神经根病和椎体滑脱）手术的成年人群，并报告了成本分析、CEA或增量成本效益比的结果。
共纳入17项研究。三项研究评估了MIS与开放椎间盘切除术的结果。所有三项研究均报告MIS组的总成本在统计学上显著低于开放手术组，且质量调整生命年（QALY）的增加相似。两项研究报告了MIS与开放椎板切除术的成本差异，MIS组的总成本显著更低。十二项研究报告了MIS与开放腰椎融合术相对直接成本的研究结果。其中，比较单节段MIS经椎间孔腰椎椎间融合术（TLIF）和开放TLIF的四项研究中有三项报告MIS手术的总成本更低。六项研究报告了单节段和双节段TLIF手术的成本评估。除一项研究中双节段融合的亚组分析外，所有研究中MIS组的总成本均低于开放融合组。这六项研究中有三项报告了成本效益（成本/QALY）。在所有三项研究中，MIS融合术被发现比开放融合术更具成本效益。
所审查的研究方法质量较差至中等。总体而言，研究报告MIS与开放手术相比成本降低，并表明成本效益更好，特别是在MIS与开放单节段和双节段TLIF手术中。大多数研究存在较高的偏倚风险。因此，本综述无法从成本效益角度明确推荐MIS优于开放手术。
脊柱减压和融合手术的发病率以及医疗服务的经济限制持续增加。本研究旨在确定脊柱手术常见方法的成本和临床效果。
3a。
