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BACKGROUND CONTEXT Excessive use of postoperative imaging after lumbar surgery has been documented, becoming a target for cutting costs. This must be balanced with the patient's need for information and allay their postoperative concerns. PURPOSE To determine the incidence and associated costs of patient interactions with the healthcare system, outside the standard follow up routine, in the first postoperative year. STUDY DESIGN Retrospective longitudinal cohort. PATIENT SAMPLE Consecutive series of 200 patients who underwent lumbar fusions from 2018 to 2019 from a multi-surgeon single tertiary spine center. OUTCOME MEASURES All healthcare encounters: phone calls, office and emergency department visits, and additional testing METHODS A consecutive series of 200 patients who underwent lumbar fusions from 2018 to 2019 were identified. All non-routine healthcare encounters: phone calls, office and emergency department visits, and additional testing were collected. Direct costs for all healthcare services were determined using the Medicare Allowable rates. Indirect costs were determined using local, median income, length of office visits, and distance from the clinic to the patient's home. RESULTS Of 200 patients, 14 with thoracic fusion were excluded. The mean age of the 186 included patients was 58.26 years and 85 (46%) were male. Forty-seven percent (87/186) had only routine postoperative visits and 24 had revision surgery. Seventy-five patients made a total of 102 phone calls, 55 office visits, leading to 38 diagnostic studies none of which led to an additional intervention. Using Medicare Allowable rates, the mean direct cost was $776 per patient and the using a median income of $16/h the mean indirect cost was $124 per patient. There were no differences in the baseline characteristics among the patients who only had routine post-op encounters, had non-routine encounters or had a repeat surgery. CONCLUSIONS Forty percent of the patients undergoing lumbar surgery had a healthcare encounter outside their routine follow up that did not result in additional intervention after their index operation. These potentially unnecessary encounters create additional cost and inconvenience to both the patient and healthcare system. Providing patient reassurance is important and providers should identify ways to reduce associated costs through patient education, virtual visits, or new technologies to monitor patient's postoperative progress.

BACKGROUND CONTEXT Health literacy, defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,” has been demonstrated to affect access to care and appropriate healthcare utilization. PURPOSE To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain. STUDY DESIGN Cross sectional. PATIENT SAMPLE Patients seen at a multisurgeon spine specialty clinic. OUTCOME MEASURES Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0–10) for back and leg pain. METHODS The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities. RESULTS Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p = .017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8). CONCLUSIONS Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes.

BACKGROUND CONTEXT The recent opioid crisis in the US highlights opioid related side-effects and the dire need to reduce opioid exposure with alternative approaches. Prior studies reported that as many as 25% of opioid naive patients undergoing lumbar fusion surgery are still consuming opioids at 2 years postoperative. Currently, opioids are a primary component of anesthesia during spinal surgery. We developed an opioid sparing anesthesia (OSA) protocol for lumbar spinal fusion surgery to mitigate opioid exposure. PURPOSE To compare surgical, peri- and postoperative process measures and in-hospital opioid consumption in patients receiving OSA vs traditional anesthesia. STUDY DESIGN/SETTING Retrospective, single center propensity-matched observational cohort study. PATIENT SAMPLE Patients who underwent 1-4 level lumbar fusion for degenerative conditions. OUTCOME MEASURES Daily and total opioid consumption in morphine milligram equivalents (MME). Methods Patients undergoing Results Of 143 OSA patients meeting inclusion criteria, 134 OSA patients were successfully propensity matched to 134 non-OSA patients. Consistent with propensity matching, there was no difference in baseline demographic parameters between cohorts. Patients undergoing OSA had reduced EBL (197mL vs 324mL, p=0.000) and OR time (153min vs 193min, p=0.000) compared to non-OSA. Emergence time (9.9min vs 11.6min, p=0.151) and PACU time (90min vs 88min, p=0.688) was similar between cohorts. There was no difference in LOS (3.3day vs 3.5 days, p=0.599). Daily opioid consumption was reduced from POD 1 (114MME vs 139MME, p=0.002) and maintained each day with decreased total consumption (195MME vs 272MME, p=0.002). Pain score on transfer out of PACU was decreased for OSA patients as well (4.8 vs 6.0, p=0.000). Conclusions In a matched comparison of OSA vs traditional anesthesia for 1-4 lumbar spinal fusions in degenerative conditions we found a reduction in EBL, OR Time, PACU pain scores, and daily/total opioid in hospital consumption. The findings of this pilot study justify ongoing efforts to optimize OSA and undertake larger prospective studies of OSA protocols. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT A recent administrative database (PearlDiver) study reported increased 30-day complications with the utilization of robotic-assisted (RA) enabling technology. The authors reported increased fixation-related complications (3%) and infection rates (19%) in RA surgeries. Although there is ample evidence regarding improved pedicle screw accuracy with RA surgery, the complication profile has been called into question. PURPOSE The objective of the study is to compare 90-day complication rates between RA and nonrobotic-assisted (NRA) lumbar spinal fusions in propensity-matched cohorts. STUDY DESIGN/SETTING Retrospective single center observational propensity-matched observational cohort study. PATIENT SAMPLE Patients who underwent 1- to 3-level lumbar fusion surgery for degenerative conditions. OUTCOME MEASURES Surgical and medical (major/minor) complications at intraoperative, immediately postoperative, 30- and 90-day postoperative intervals. Additionally, reoperations and readmissions within 90 days. METHODS Of 146 RA cases that met inclusion criteria, 114 were successfully propensity matched to 114 patients from 214 cases who had 1-3 level lumbar fusion without robotic assistance based on age, sex, BMI, smoking status, surgical approach (posterior-only or anterior-posterior), ASA grade, revision vs primary, number of surgical levels, and number of interbody levels. We excluded tumor, trauma, infection or deformity cases. Continuous variables were compared using unpaired t-tests and categorical variables were compared using Fisher's exact test with significance set at 0.05. RESULTS Consistent with propensity matching, there was no difference in patient demographics and baseline characteristics between groups. Neither group had intraoperative fixation-related complications or required a return to OR for malpositioned screws. All cause intraoperative complication rates were similar between NRA (5.3%) and RA groups (10.5%, p=0.366). Immediate postoperative medical complication rate was also similar between NRA (6.1%) and RA groups (1.8%, p=0.089). Thirty-day complication rates (NRA:15.8% vs RA:12.3%, p=0.446), 90-day complication rates (NRA:15.8% vs RA:14.9%, p=0.854), reoperation rates (NRA:6.1% vs RA:3.5%, p=0.354), and readmission rates (NRA:7.0% vs RA:6.1%, p=0.789) showed no difference between NRA and RA groups. There was no difference between return to OR for infection between the cohorts (NRA:6 [5%] vs RA:1 [0.8%], p=0.119). There was, however, improved length of stay (LOS) in the RA group compared to NRA group (2.5 vs 3.17 days, p=0.018). CONCLUSIONS In propensity-matched cohorts, patients undergoing 1- to 3-level level RA posterior lumbar fusion for degenerative conditions did not have increased 90-day complication rate, and had a shorter length of stay compared to NRA patients. There findings differ from a prior administrative database study as the RA group in the current study had 0% return to OR for malpositioned screws and 0.8% return to OR for infection. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Recent studies suggest as much as 25% of patients undergoing spine surgery are still on opioids two years later. In response, we developed protocols to minimize opioid consumption following elective spine surgery. Our goal was to evaluate patients undergoing single-level Anterior Lumbar Interbody Fusions (ALIF ± posterior fixation) on MMPC compared to patients who were not (nonMMPC). PURPOSE To determine if the combination of an oral preoperative pain cocktail with transverse abdominis plane (TAP) block (multi-modal pain control: MMPC) will reduce length of stay (LOS), ileus, and in-hospital opioid consumption. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE Consecutive patients undergoing single-level ALIF for degenerative lumbar conditions by a single-surgeon. OUTCOME MEASURES Length of stay (LOS), incidence of ileus and in-hospital opioid consumption. METHODS A retrospective review of a prospective, single-surgeon, surgical database was utilized for consistency in technique. Consecutive patients undergoing single-level ALIF for degenerative lumbar conditions were identified before and after initiation of the MMPC. The MMPC consisted of a preop oral regimen of cyclobenzaprine (10mg), gabapentin (600mg), acetaminophen (1g) and methadone (10mg). Postoperatively they received a bilateral transverse abdominis plane (TAP) block with 0.5% Ropivicaine. Our primary outcome was total, in-hospital opioid consumption (morphine milligram equivalents: MME). RESULTS There were 68 patients in the MMPC cohort and 39 in the nonMMPC cohort. There was no difference in baseline demographics such as sex, BMI, smoking, or preoperative opioid use between the two groups. The MMPC cohort was older (56.7 vs 51.1 years, p=0.026). Similar rates of ileus (4 vs 6, p=0.102), no difference in LOS (3.8 vs 4.5, p=0.246) and no difference in index hospital costs was found. Although there was no difference in day of surgery MMEs (58.5 vs 68.9, p=0.387), cumulative MMEs each day after surgery was significantly lower in the MMPC cohort, with final cumulative MMEs being reduced by 62% (120.2 vs 314.8, p CONCLUSIONS The use of a MMPC regimen in patients undergoing single-level ALIF for degenerative conditions reduced opioid consumption starting on POD 1, resulting in a cumulative reduction of 62%. Further research should strive to minimize opioid use and the downstream effects. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Transforaminal Lumbar Interbody Fusion (TLIF) techniques have evolved from open approaches with dissection to the lateral gutters, to navigation to improve pedicle screw placement accuracy, to robotic assistance to further minimize soft tissue dissection. It is unclear if these technologies improve process measures and minimize variability in surgical technique. PURPOSE To determine if Blood Loss, Operative Time and Length of Stay will be lower with less variability with Robotic, followed by Navigated and Open TLIF. STUDY DESIGN/SETTING Propensity matched longitudinal cohort. PATIENT SAMPLE Consecutive series of patients undergoing primary single-level TLIF. OUTCOME MEASURES Blood Loss, Operative Time and Length of Stay. METHODS A consecutive series of patients undergoing primary single-level Robotic-Assisted TLIFs (RA-TLIF, N=40) were propensity matched to patients undergoing Navigated (NavTLIF, N=51) and Open TLIF (OpTLIF, N=44) using age, sex, smoking status, BMI and ASA grade. RESULTS After propensity matching, 34 cases were included in each cohort. OR Time (184±37 vs 197±48 vs 219±50, p=0.007) was lowest and had the least variability in RA-TLIFs followed by NavTLIF and OpTLIF. Length of Stay (1.5±0.9 vs 2.5±1.2 vs 4.2±1.7, p=0.000), estimated blood loss (254±259 vs 325±288 vs 489±328, p=0.004), drain output (234±257 vs 250±137 vs 653±407, p CONCLUSIONS Operative time was lowest and had the least variability in RA-TLIFs followed by NavTLIF and OpTLIF. Length of stay, blood loss, drain output, total visible blood loss, and total volume of blood products transfused was lowest in RA-TLIFs followed by NavTLIF and OpTLIF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Posterior fixation with interbody cage placement can be accomplished via numerous techniques. In attempts to expedite recovery by limiting muscle dissection, the midline interbody fusion (MIDLIF) has been described. More recently, we have developed a robotic-assisted MIDLIF (RA-MIDLIF) technique. Introduction of new technology can potentially be expensive and burdensome. PURPOSE The purpose of this study was to compare index episode of care parameters between patients undergoing either traditional open TLIF (tTLIF), MIDLIF, or RA-MIDLIF. STUDY DESIGN/SETTING Retrospective review of a prospective, multisurgeon, surgical database. PATIENT SAMPLE Consecutive patients undergoing 1- or 2- level RA-MIDLIF, tTLIF or MIDLIF. OUTCOME MEASURES Estimated blood loss (EBL), operative tme (OR Time), length of stay (LOS), total direct hospital cost. METHODS A retrospective review of a prospective, multisurgeon, surgical database was utilized. Consecutive patients undergoing 1- or 2-level RA-MIDLIF for degenerative lumbar conditions were identified and propensity-matched based on age, sex, smoking status, BMI, ASA grade and levels fused to patients undergoing tTLIF or MIDLIF. LOS, EBL, OR Time and direct hospital cost for the index surgical admission were compared. RESULTS Of 55 RA-MIDLIF cases identified, 52 were successfully propensity-matched to patients undergoing tTLIF or MIDLIF. Consistent with propensity matching, there was no difference in age, sex, BMI, ASA grade, smoking status or levels fused. The mean direct hospital cost was similar across all cohorts. Patients undergoing RA-MIDLIF had a shorter average LOS (1.53 days) compared to either MIDLIF (2.71 days) or TLIF (3.58 days). Both MIDLIF and RA-MIDLIFs had lower EBL and less OR time compared to both tTLIF. CONCLUSIONS Despite concerns for additional cost and time while introducing navigation or robotic technology, a propensity-matched comparison of our first 52 robotic-assisted MIDLIF surgeries compared to tTLIF and MIDLIF showed promising results for reducing OR time, EBL, LOS and without increasing cost. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Provisions in the Patient Protection and Affordable Care Act (PPAC) include alternative payment models that shift away from fee-for-service reimbursement and provide incentives to improve value. These reimbursement models could incorporate the post-discharge facility care and it is therefore important to identify drivers of additional cost, especially in the setting of unexpected non-home discharge. PURPOSE To identify factors associated with being discharged to a non-home location after an elective 1-2 level instrumented lumbar fusion that, if identified, can be useful to allow for early post-discharge planning. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE Patients undergoing 1-2 level instrumented lumbar fusions for degenerative lumbar conditions from 2016 to 2018. OUTCOME MEASURES Non-home discharge. METHODS Hospital administrative database and electronic medical record analysts identified consecutive patients undergoing 1-2 level instrumented lumbar fusions for degenerative lumbar conditions from 2016 to 2018. Discharge disposition was determined as home vs non-home (NH). A regression analysis was used to determine associations between NH discharge and an underserved zip code, ASA grade, marital status, race, insurance type, smoking status, BMI, number of levels, approach and revision surgery. RESULTS A total of 1,502 patients (601; 40% male) were included with a mean age of 57.5 years. The majority were discharged home (1,216; 81%). Of the 286 (19%) not discharged home, the majority went to a skilled nursing facility (248). Factors associated with a NH discharge were living in an underserved zip code, not being married, being on government insurance, having more levels fused, higher BMI and older age. Length of stay (5.64 vs 3.03 days, p CONCLUSIONS Patients living in an underserved zip code, not married, higher BMI, older, and having government insurance are more likely to be discharged to a non-home facility after undergoing 1-2 instrumented lumbar fusions. Identification and early intervention to place these patients even before admission may decrease the length of hospital stay and cost. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Our previous study showed that prescribing patterns, more than surgery invasiveness or patient factors, affect post-operative opioid consumption. Since then we have instituted a Standard Escalation Pain Protocol (SEPP): patients receive 0-60 Morphine Milligram Equivalents (MME) above their baseline pre-op MME after surgery. PURPOSE The purpose of this study is to evaluate how prescribing patterns affect immediate postoperative opioid consumption in patients undergoing 1- to 2-level posterior lumbar interbody fusion with a navigated or robotic-assisted, midline exposure (MIDLIF). STUDY DESIGN/SETTING Single surgeon consecutive series. PATIENT SAMPLE Patients with degenerative lumbar pathology who had a MIDLIF from 2017 to 2018 were identified. OUTCOME MEASURES In-hospital opioid consumption. METHODS Patients with degenerative lumbar pathology who had a MIDLIF from 2017 to 2018 were identified and divided into two cohorts: patients who had surgery before the institution of SEPP (PreSEPP) and those who had surgery after (PostSEPP). Length of stay and daily opioid consumption were extracted by EMR data analysts unaware of the purpose of the study. RESULTS The PreSEPP (N=34) and PostSEPP (N=27) patients were similar at baseline in age, sex distribution, ASA grade, BMI and smoking status. Pre-Op (2.2 vs 3.6, p=0.630) and Post-op Day-0 (POD-0, 52.5 vs 38.8, p=0.192) MME consumption was similar between the two groups. At POD-1, cumulative MME consumption was higher in the Pre-SEPP (131.7) compared to the PostSEPP group (76.0, p=0.004) and this was maintained up to discharge (54% total MME reduction). Length of stay was also longer in the PreSEPP (1.97 days) compared to the PostSEPP group (1.37 days, p=0.004). CONCLUSIONS The use of a standard escalation pain protocol decreases in-hospital opioid consumption by 54% and shortens length of stay after 1-2 level lumbar spinal fusion. Similar to our previous study, prescribing pattern is an important factor affecting post-op opioid consumption. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT In 2016 alone, 19,413 deaths were attributed to prescription opioid overdoses. Understanding the drivers of opiate consumption in postoperative lumbar spinal fusion patients is a high priority. PURPOSE To determine if surgical invasiveness and/or preoperative opiate use influences immediate postoperative opiate consumption. STUDY DESIGN/SETTING Propensity matched longitudinal cohort. PATIENT SAMPLE Patients from a multi-surgeon, single spine specialty center with degenerative lumbar pathology who underwent an instrumented posterior lumbar decompression and interbody fusion (MIDLIF or TLIF). OUTCOME MEASURES Oswestry Disability Index, morphine equivalent doses (MED) from postoperative day (POD) #0 through POD #4. METHODS A single-center, multi-surgeon, retrospective review identified patients with degenerative lumbar pathology who underwent an instrumented posterior lumbar decompression and interbody fusion (MIDLIF or TLIF). Patients in each cohort were propensity-matched based on age, sex, smoking status, BMI, diagnosis, ASA grade and levels fused. MED POD #0 through POD #4 were calculated. Preoperative opiate prescriptions were recorded to determine baseline opioid use. RESULTS Of 214 MIDLIF and 281 TLIF patients undergoing surgery, 33 patients in each cohort were successfully propensity matched with no differences in baseline characteristics. There was no difference in immediate postoperative mean total MED between the cohorts (MIDLIF=370, TLIF=302, p=.398). Forty-three (65%) of patients were taking opiates prior to surgery. Opiate-naive patients required less narcotics (MED=248) compared to nonopiate naive patients (MED=383, p=.071) but this was not significant. Patients taking opiates preop had worse baseline ODI (56.5 vs. 47.2, p=.023) and 1-year postop ODI (46.3 vs. 30.9, p=.015). CONCLUSIONS Neither surgical invasiveness nor preoperative opiate use have an impact on immediate postop opiate consumption. This is likely secondary to non-individualized prescribing patterns. Patients taking preop narcotics have worse baseline, 1-year, and improvement in ODI following 1- and 2-level MIDLIFs or TLIFs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT It is unclear if patients with recurrent disc herniation (RDH) benefit from a concurrent fusion compared to a repeat decompression alone. No studies are available comparing outcomes of decompression alone (D0) versus decompression and fusion (DF) for RDH. PURPOSE The purpose of the study is to compare clinical outcomes and revisions in patients with first episode recurrent disc herniation treated with decompression only compared to decompression and concommittant fusion. STUDY DESIGN/SETTING Multicenter longitudinal observational cohort. PATIENT SAMPLE Patients enrolled in the Quality Outcomes Database (QOD) from three sites with a first episode of RDH and one- to two-level surgery. OUTCOME MEASURES Numeric rating scales (0–10) for back and leg pain, Oswestry Disability Index (ODI), EuroQOL-5D (EQ-5D), revision surgery. METHODS Patients enrolled in QOD from three sites with a first episode of RDH and one- to two-level surgery were identified. Demographic, surgical and radiographic data including the presence of listhesis and extent of facet resection on CT or MRI prior to the index surgery were collected. Patient Reported Outcomes (PROs), including back and leg pain, ODI and EQ-5D, were collected pre-op and at 3 and 12 months post-op. RESULTS Of 94 cases identified, 55 had D0 and 39 had DF. The patients were similar in age, sex distribution, smoking status, BMI, ASA grade and surgical levels. Presence of listhesis (D0=7, DF=5, p=.800) and extent of facet fusion (D0=19%, DF=16%, p=.309) prior to index surgery were similar between the two groups. EBL (D0=26cc DF=329cc p CONCLUSIONS For a first episode recurrent disc herniation, surgeons can expect similar outcomes whether patients are treated with decompression alone or decompression and fusion. Despite similarities in baseline demographic, PRO and radiologic data, variables that lead a surgeon to choose decompression alone or decompression and fusion are unknown and can lead to selection bias. Further studies are needed to identify clear indications for fusion in patients with first episode recurrent disc herniation.

BACKGROUND CONTEXT Posterior instrumented lumbar fusions are commonly performed utilizing interbody fusions. Recently, a minimally invasive technique of midline exposure with cortical bone trajectory screw fixation has been described (MIDLIF). The goal is to limit muscle dissection, decreasing surgical morbidity and expedite recovery. PURPOSE The purpose of this study was to compare index episode of care (iEOC) cost between patients undergoing MIDLIF versus tTLIF. STUDY DESIGN/SETTING Multi-surgeon single-center spine specialty tertiary practice. PATIENT SAMPLE Consecutive patients undergoing 1- or 2-level MIDLIF or tTLIF for degenerative lumbar conditions were identified. OUTCOME MEASURES Index episode of care cost data for surgical and hospital stay parameters and included actual, direct, hospital cost. METHODS A retrospective review of a prospective, multi-surgeon, surgical database was utilized. Consecutive patients undergoing 1- or 2-level MIDLIF or tTLIF for degenerative lumbar conditions were identified. Patients in each cohort were propensity-matched based on age, sex, smoking status, BMI, diagnosis, ASA grade and levels fused. iEOC cost data was collected for surgical and hospital stay parameters and included actual, direct, hospital cost for the index surgical visit. RESULTS Of 214 and 281 patients undergoing MIDLIF or tTLIF, respectively, 105 cases in each cohort were successfully propensity-matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA score, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. The mean total iEOC was $706 ($16,604 vs. $17,310) lower for MIDLIF versus tTLIF. There was no difference in implant (p=.193) or biologic (p=.145) cost but blood utilization (p=.000), OR supplies (p=.000), hospital room/board (p=.000), pharmacy (p=.010), and therapy (p=.009) costs were all significantly lower in MIDLIF. Additionally, mean LOS was decreased for MIDLIF (2.97 vs. 4.02, p=.000). CONCLUSIONS Compared to traditional open tTLIF, patients undergoing MIDLIF have several cost parameters of the iEOC that are significantly lower as well as a shorter length of stay. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.