Multicenter Cost Analysis of Osteobiologic Usage in Lumbar Spine Fusion Surgery

Introduction: A myriad of commercially available osteobiologic products (OP) have been developed to either substitute or augment traditional bone graft materials. In the current healthcare landscape, cost containment remains a foremost concern for healthcare policy. Consequently, as the utilization of these diverse products escalates, elucidating the economic impact becomes a high-priority target for healthcare institutions. We sought to describe which OP are most frequently used in spinal fusion surgeries and determine usage trends across multiple large centers.

Methods: A retrospective medical record review was performed to identify patients who underwent spinal fusion surgeries performed by multiple surgeons across three centers from 2015-2021 in which OPs were used. Collected data included surgical indication, procedure description, use of interbody device, levels fused, quantity and type of OP use, and listed price of products. Descriptive analysis was then performed using this information.

Results: A total of 859 surgeries were included in which 1,964 spinal levels were fused. The most common procedures were TLIF/PLIF (43%), PLF (31%), PTLF (11%), ALIF (8%), and XLIF (7%). The mean volume (mL) of OP used per level fused was 9.61 (PTLF), 9.28 (TLIF/PLIF), 8.26 (ALIF), 7.66 (XLIF), and 6.73 (PLF). The sum cost of all OP used by surgery type was $1,457,785 (TLIF/PLIF), $856,374 (PLF), $505,240 (PTLF), $327,240 (ALIF), and $313,740 (XLIF). The mean cost of OP used per level fused based on type of surgery was $4,196 (ALIF), $3,076 (XLIF), $2,431 (TLIF/PLIF), $1,635 (PLF), and $1,391 (PTLF). When evaluating price usage trends across categories of OP in various surgeries, cancellous bone was the cheapest and synthetic bone was the most expensive per level fused.

Conclusion : While TLIF/PLIF surgeries occurred most frequently, PTLF surgeries required the most osteobiologic product volume per level, and ALIF surgeries incurred the highest price of osteobiologic products per level fused.