Introduction: Lumbar discectomy is one of the most common procedures performed by neurosurgeons, and technological developments have transformed surgical technique, in particular the use of the operating microscope. We wished to analyze the impact of the microscope on the efficiency, cost, and complication rates in lumbar discectomy.

Methods: The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) was reviewed for patients undergoing lumbar discectomy based on current procedural terminology (CPT) code with stratification of cases where the use of operating microscope was also coded. Cost data was obtained from the Healthcare Cost and Utilization Project (HCUP).

Results: A total of 3998 patients undergoing lumbar discectomy from 2006-2010 were identified. The rate of operative microscope use was 6.7%. Lumbar discectomy with microscope use coded did not have a significantly different operative time or incidence of post-operative complications. However, the length of stay was significantly decreased. Mean hospital costs (based on length of stay) were $6340.45 for cases with microscope coded compared to $8280.05 for the discectomies without microscope use coded, which was statistically significant (p <0.001).

Conclusions: In lumbar discectomy cases for which operating microscope use was coded, there were shorter hospital stays without decreased post-operative complications or operative times. Based on our findings, the additional indirect cost of this technology may be justified and offset by earlier patient discharges and subsequent reduced total direct costs.

Patient Care: Highlight the positive impact on length of stay and cost with the use of the operating microscope in lumbar discectomy.

Learning Objectives: 1) Outline the history of lumbar discectomy techniques 2) Highlight the importance of operating microscope use in lumbar discectomy 3) Examine the impact of the operating microscope on outcomes and cost in lumbar discectomy

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