Cost comparison of minimally invasive transforaminal lumbar interbody fusion: experience from Nigeria and the United States

Why clinicians should know about it

• Picked for Spine Surgery (paper of the day, 14 October 2026).

Abstract

INTRODUCTION: The total cost of patient care for minimally invasive spine surgery is generally lower than for open spine surgeries, primarily due to shorter length of hospital stay (LOS), shorter surgery duration (SDn), lower perioperative morbidity, and reduced narcotic pain medication use. Due to prohibitive costs, neither surgical approach is readily accessible in developing countries. Objectives-to report our experience with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in Nigeria, a lower-middle-income country, and to compare it with data from our prior practice in the United States (U. S.). METHODS: An observational, comparative analysis was conducted between two retrospective cohorts of MIS-TLIF patients in Nigeria and the U. S. Demographic data, perioperative parameters (SDn, estimated blood loss [EBL], and LOS), perioperative surgical site complications, and patient-reported outcomes (Numeric Rating Scale [NRS] and Oswestry Disability Index [ODI]) for patients who underwent MIS-TLIF for degenerative spine disease from June 2018 to May 2022 in the Nigerian practice were retrieved from the database. Minimal clinically important differences (MCID) in patient-reported outcomes (PROs) were defined as a two-point change on the NRS and a 5.9-20-point difference on the ODI. The hospital's accounts section provided the direct costs, which were converted from Nigerian Naira to U. S. dollars. Data from both cohorts, which had similar surgical indications, the same lead surgeon, and similar operative techniques and perioperative management, were compared. RESULTS: The median age of the 65 patients was 61 years; 37 were female. The median SDn, EBL, and LOS were 190 min, 100 mL, and 3 days, respectively. Compared with the MIS-TLIF subgroup in the previous cohort, this cohort had higher mean SDn (186.2 versus 161.0 min, p < 0.001), EBL (104.8 versus 95.0 mL, p = 0.264), and LOS (4.1 versus 3.6 days, p = 0.558), as well as higher perioperative surgical site complication rates (9.2% versus 7.0%, p = 0.749). As in the U. S. cohort, PROs showed statistically significant improvement and met the MCID from baseline to the 12-month follow-up. The mean cost was lower in this study ($9,530 versus $20,960, p < 0.001). CONCLUSION: MIS-TLIF direct costs are lower in our Nigerian practice than in a developed country, despite outcomes that are mostly statistically similar.

Abstract as published, via PubMed.