{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T15:26:42Z","timestamp":1793978802601,"version":"4.8.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Minimally invasive surgery (MIS) is a reasonable treatment option for lumbar spondylolisthesis, but its long-term cost-effectiveness is not well established. Herein, the authors describe the 5-year cost-effectiveness of posterior MIS using prospective data from the multicenter Quality Outcomes Database (QOD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Patients from the Spine CORe\n                      <jats:sup>TM<\/jats:sup>\n                      study group\u2019s multicenter, prospectively collected QOD grade 1 lumbar spondylolisthesis dataset who had undergone single-stage posterior surgery were included. Gains in quality-adjusted life years (QALYs) were quantified using EQ-5D scores across 60 months. Costs from index surgeries and related reoperations were estimated using Medicare rates for inpatient care and Current Procedural Terminology rates for outpatient care. Validation was achieved via price transparency diagnosis-related group (DRG) charges and charge\/cost ratios (CCRs). The cost per QALY gained was ultimately calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of the 608 patients identified as having undergone single- or multiple-stage surgery, 559 underwent single-stage posterior surgery, 242 via MIS (mean age 64.3 \u00b1 11.7 years, 71.1% arthrodesis rate) and 317 via open surgical approaches (mean age 61.3 \u00b1 12.2 years, 78.5% arthrodesis rate). Length of stay (LOS) was 2.3 \u00b1 1.9 days for patients in the MIS group and 3.1 \u00b1 1.7 days for those in the open surgery group (p &lt; 0.0001). Operative duration was similar between the groups (171.7 \u00b1 93.3 vs 174.2 \u00b1 72.3 minutes, p = 0.739), whereas estimated blood loss was 108.3 \u00b1 102.2 mL for the MIS group and 251.9 \u00b1 230.6 mL for the open surgery group (p &lt; 0.0001). Moreover, 6.2% of patients in the MIS group and 7.9% in the open surgery group underwent related reoperations; 5.0% and 7.6% of patients, respectively, had complications. Thirty-day readmission was required in 1.2% of patients in the MIS group and 2.5% in the open surgery group. DRG costs were stable between our model and the CCR-based model, providing external validation. The mean QALY gain was 1.06 (95% CI 0.92\u20131.20) for MIS and 0.94 (95% CI 0.83\u20131.05) for open surgery (p = 0.191); the mean QALY gain was 1.09 (95% CI 0.92\u20131.25) versus 0.95 (95% CI 0.82\u20131.08), respectively, among those who underwent arthrodesis (p = 0.193) and 0.99 (95% CI 0.71\u20131.28) versus 0.90 (95% CI 0.64\u20131.16) among those who underwent decompression only (p = 0.628). The mean cost of MIS was significantly lower ($31,822) than that of open surgery ($39,151; p = 0.001). Among those who underwent arthrodesis, the mean cost was $41,916 for MIS versus $46,626 for open surgery (p = 0.031). Among patients who underwent decompression only, the mean respective cost was $7021 versus $11,780 (p = 0.004). The mean cost per QALY gained was $29,995 for MIS and $41,635 for open surgery (p = 0.0017), $38,501 versus $48,998 among those who underwent arthrodesis (p = 0.0193), and $7073 versus $13,100 among those who underwent decompression only (p = 0.0123).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>MIS for grade 1 lumbar spondylolisthesis demonstrated a 60-month cost per QALY gained of $29,995, which was significantly lower than open surgery\u2019s $41,635. Differences were driven by LOS, complications, and reoperations, and MIS remained more cost-effective even after stratification for arthrodesis. However, both surgical approaches remained below the $100,000 willingness-to-pay threshold, highlighting overall long-term cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.5.spine26177","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:01:11Z","timestamp":1788307271000},"page":"738-747","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of minimally invasive surgery for grade 1 lumbar spondylolisthesis: a 5-year Quality Outcomes Database study"],"prefix":"10.3171","volume":"45","author":[{"given":"Farhan A.","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Chabot","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, University of Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica F.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Utah NeuroSpine, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Glassman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Foley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Potts","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul K.","family":"Kim","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming G.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Slotkin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Virk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Spine (Phila Pa 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