1. Advances in Spine Care Could Save the U.S. Healthcare System Billions
David P. Rouben, M.D.
River City Orthopedic Surgeons
Louisville, Ky.
September, 2005

2. Cost of Low Back Pain Costs U.S. Billions
The Common Cold-only medical condition treated more frequently than Low Back Pain
80% of U.S. Population experiences Low Back Pain
Low Back Pain Incidence- 4 times faster growth than U.S. Population

3. Treating Low Back Pain Costs U.S. Billions
126 million in the U.S. Workforce
Aging workers= Declining U.S. workforce
20% Workers Disabled for up to 6 mo/yr
Injured Workers Lose Pay but Gain Disability
Employers Face Recurring Costs of
Injured Worker Medical Care
Lost Productivity
New Worker Recruiting-Retraining-Benefits

4. Cost of Low Back Pain Costs U.S. Billions
U.S. Work Comp Injuries Cost $160 Billion in 2005
41% of Injuries are Low Back Pain
25 million Workers are off for 6 months
630,000 (2.5%) Workers Fail Non-Operative Tx

5. Cost of Low Back Pain Costs U.S. Billions
Only 50% of Workers treated via “Traditional Open Lumbar Fusion Techniques” will return to work
Only 27% of Workers undergoing More than One back surgery will Return to Work
50% of “Successful” Open Fusions Experience a Recurrence of Pain and Disability

6. Treating Low Back Pain Minimally Invasive Decompression
Non-Surgical Treatments have Changed Little for 20 years
Technical Advances in Surgery offer Improved Results
Minimally Invasive Decompression
Minimally Invasive TLIF / PLIF

7. Surgical Treatment Low Back Pain
Goals-
Speedy Return to Work
Reproducible- Consistent-Efficacious Treatment
Minimize Lifestyle Change-Disability

8. OPEN TLIF

9. MAST TLIF

10. MAST TLIF vs. OPEN TLIF By Comparison MAST TLIF Patients spend:
88% Less time in the Hospital
50% Less time in Recovery Room
50% Less Narcotics in Hospital
33% Less Blood Loss, No Transfusions
39% More Return to Work

11. MAST TLIF vs. OPEN TLIF Overall Savings: 45% Less or $24,336
Major Hospital/Procedural Cost savings:
Recovery Room Charges:
59% Less, $682
In-Patient Hospital Charges:
97% Less, $13,601
Blood Transfusion Charges:
100% Less, $2,518

12. MAST TLIF vs. OPEN TLIF

13. MAST TLIF vs. OPEN TLIF

14. MAST TLIF BENEFITS 70% Less Pain than before Surgery
90% Return to Work within 10 weeks

15. MAST TLIF only represents a small number of total TLIFs
Training and Additional Data is needed to make MAST TLIF the new “Gold Standard”

16. Potential Cost Savings MAST TLIF
213,000 lumbar fusions will be performed in the U.S. in 2005
15% of all Lumbar Fusions (31,000)- Traditional Open TLIF’s

17. Potential Cost Savings MAST TLIF
Change 31,000 Open TLIF’s
To MAST ?
$754 Million Savings

18. Potential Cost Savings MAST TLIF
If All Lumbar Fusions performed as
MAST
$5.2 Billion Savings

19. MAST TLIF Published Data
Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF). Journal Spinal Disorders Technique. Volume 18, supplement 1, February 2005.
49 patients MAST TLIF
Operative time averaged 240 minutes.
Estimated blood loss averaged 140 mL.
Mean length of hospital stay was 1.9 days.
Improvements in average Visual Analogue Pain Scale and Oswestry Disability Index (preoperative to last follow-up) scores were and 46-14, respectively.
At last follow-up, all patients had solid fusions by radiographic criteria.

20. MAST TLIF Bibliography
Foley KT, Smith MM. Microendoscopic Disectomy. Technique Neurosurgery. 1997;3:
Foley KT, Gupta SK, Justis JR, et al. Percutaneous pedicle Screw fixation of the lumbar spine. Neurosurgery Focus. 2001;10:10
Foley KT, Holly LT, Schwender JD. Minimally Invasive lumbar fusion. Spine. 2003;28:S26-S35.
Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF). Journal Spinal Disorders Technique. Volume 18, supplement 1, February 2005.

21. Advances in Spine Care Could Save the Healthcare System Billions
Q & A