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Mick Perez-Cruet, M.D.

Introduction: Lumbar spinal fusion surgery is performed to alleviated debilitating back pain symptoms due to a variety of spinal conditions including spondylolisthesis with or without spinal stenosis. Sources of bone graft can include autograph, allograft or bone substitutes. The BoneBac Press (Thompson MIS, Salem, NH) was developed to collect drilled local bone collected during the decompression and or approach (Figs. 1-3). This study analyzed the cost savings and effectiveness of collecting local bone, need for additional allograft, and fusion rates while preforming minimally invasive transforaminal lumbar interbody fusion (MITLIF).

Methods: A retrospective analysis was preformed of 93 patients who received MITLIF (using Thompson MIS TLIF system). One level MITLIF was preformed using the in 95% of patients. The amount of local autography collected using the BoneBac Press was recorded. The amount of additional allograph supplement was also recorded for each case and the ratio of autograph to allograph used (Figs. 4-8). The cost of each surgery was estimated based on the allograph savings.

Results: The average autograft volume collected was 8.01cc/case, with a total of 753cc collected over the 93 patients analyzed. 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 cost savings. The estimated total savings for this series of patients was $342,615.00 (Fig. 9). A greater than 95% fusion rate was achieved based on dynamic radiographic assessment at 3, 6, and 12 month post-operative intervals (Fig. 10). No patient returned to OR for revision surgery at the MITLIF level.

Conclusions: The use of BoneBac Press harvested morselized autografts with or without supplemental allografts to achieve MITLIF is an extremely cost effective method of achieving high rates of spinal fusion. Further multi-center prospectively randomized trials might provide additional cost benefits and improvements in patient generated outcomes.

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