Introduction: The cost of TLIF surgery has markedly increased in the last 10 years. The sources of bone graft can include autograft, allograft or bone substitutes. The BoneBac Press (Thompson MIS, Salem, NH) was developed to collect drilled local bone collected during the decompression. The cost sav-ings of this series is estimated regarding the effectiveness of collecting local bone, need for addi-tional allograft, and fusion rates.
Methods: A retrospective review over a 6-year period included 403 patients (60.8% female, 39.2% male), mean age was 64.1±12.5 years with refractory debilitating back pain from various pathologies. The amount of local autograft collected using the BoneBac Press was recorded and the additional allo-graft supplement also for each case and the ratio of autograft to allograft used. The cost of each surgery was estimated based on the allograft savings, variables analyzed included surgical time, intra- and post-operative complications neurological and non-neurological, autograft harvested, fu-sion rate, cost savings, post-operative lengh of stay, re-operation rates, and patient generated out-comes including visual analogue scale (VAS) for pain, Oswestry disability index (ODI) and Short Form 36.
Results: The total estimate of collected bone graft is 3224cc collected over the 403 patient's analyzed, aver-age 8.01cc/case. The percentage of autograft to allograft used ranged from 42% - 333% with the vast majority of cases using 2/3 autograph to 1/3 allograph. Cost savings range from $1820.00 to $6145.50 per case with an average $4965.43/case. The estimated average total savings for this se-ries of patients was $1.3 million. A greater than 95% fusion rate was achieved based on dynamic radiographic assessment at 3, 6, and 12 month post-operative intervals.
Conclusions: Marked cost savings and fusion rate were achieved using the BoneBac Press harvested morselized autografts. More randomized trials might provide additional cost benefits beside excellent patients outcomes.
Patient Care: By minimizing the cost and increasing the fusion rate that were achieved using the BoneBac Press harvested morselized autografts.
Learning Objectives: Marked cost savings and fusion rate were achieved using the BoneBac Press harvested morselized autografts.