Operative Neurosurgery 29:209–218, 2025
Microdiscectomy (MD) provided greater value than transforaminal endoscopic discectomy (TED) for lumbar disc herniations at this institution, with higher improvement in patient-reported outcomes per dollar spent and shorter operative times. TED had higher costs and a steeper learning curve, but similar reoperation rates.
• This study compares the value of transforaminal endoscopic lumbar discectomy (TED) and microdiscectomy (MD) for lumbar disc herniation using a novel Operative Value Index (OVI).
• OVI measures percent change in Oswestry Disability Index (ODI) per $1000 spent intraoperatively, integrating patient outcomes and time-driven activity-based costing.
• MD had a significantly higher OVI, lower operative times, and lower intraoperative costs than TED; no significant difference in length of stay or reoperation rates was found.
• Only 43.5% of TED cases achieved clinically important improvement (MCID), compared to 66.3% for MD.
• TED was mainly used for foraminal herniations and had a higher proportion of older patients and comorbidities.
• Longer OR setup times and higher costs for TED may relate to the learning curve and surgeon experience.
• Authors suggest OVI is a practical, real-time value metric but note limitations including small TED sample size and retrospective design.
• Future studies should assess long-term outcomes, total episode costs, and track OVI as surgeons gain TED experience.
You must be logged in to post a comment.