As we have shown in this study, the complications associated with MIS XLIF fusion for spondylolisthesis are notably less than the complications reported with traditional open approaches. Furthermore, open spinal fusions have been reported to have much longer hospitalizations (ALIF: 3.9 days [28], PLIF: 9.7 days [29], or TLIF: 5.5 days [38]) than the 1.2 days we report herein. A recent study, compared selleckchem the operating costs for a hospital performing XLIF and open PLIF in the treatment of two-level degenerative spinal conditions showed a decrease in operating costs by 9.6% (including the higher price for XLIF implants) with a 1.2 compared with 3.2 day hospital stay (resp.) with significantly fewer transfusions and residual events [39].

A similar study of open and miniopen posterior found significantly lower hospital charges, complications, length of stay, and transfer to inpatient rehabilitation using minimally invasive posterior lumbar interbody fusion (PLIF) compared with open PLIF [40]. It stands to reason that modern surgical fusion options��utilizing direct visualization, miniopen approaches��would be expected to yield a markedly decreased dollar cost per QALY gained because these MIS techniques require shorter hospital stays and result in fewer expensive complications.5. Conclusion XLIF is safe and effective for the treatment of grade 2 spondylolisthesis at L4-5. The use of this technique results in marked clinical and radiographic improvement which is maintained over time. The use of real-time neurologic monitoring and careful attention to technique are mandatory.

DisclosureW. Rodgers serves as a Consultant to NuVasive, the designers of the XLIF procedure. He is an inventor on four pending patents. He has been paid for teaching, receives royalties, owns NuVasive stock, serves on the advisory board, and is paid research support and travel expenses. He is also a Consultant to Exactech, makers of the majority of the bone grafting material used in the procedures discussed in this paper. Exactech also provides research support to W. Rodgers and and supports travel expenses. AcknowledgmentsThe Entinostat authors would like to acknowledge Christopher Case, M. D. (IRB Chairman, St. Mary’s Health Center IRB, Jefferson City, MO) for his assistance with paper review.