Clinical Study A cost benefit analysis of increasing surgical technology in lumbar spine fusion Peter G. Passias, MD a, *, Avery E. Brown, BS a , Haddy Alas, MD a , Cole A. Bortz, BA a , Katherine E. Pierce, BS a , Hamid Hassanzadeh, MD b , Lawal A. Labaran, BS b , Varun Puvanesarajah, MD b , Dennis Vasquez-Montes, MS c , Erik Wang, BS c , Rivka C. Ihejirika, MD c , Bassel G. Diebo, MD d , Virginie Lafage, PhD e , Renaud Lafage, MS e , Daniel M. Sciubba, MD f , Muhammad Burhan Janjua, MD g , Themistocles S. Protopsaltis, MD c , Aaron J. Buckland, MBBS, FRACS c , Michael C. Gerling, MD c a Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA b Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA c Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA d Deparment of Orthopedic Surgery, SUNY Downstate, New York, NY, USA e Deparment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA f Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore MD, USA g Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA Received 22 April 2019; revised 7 October 2020; accepted 8 October 2020 ABSTRACT BACKGROUND CONTEXT: Numerous advances have been made in the field of spine fusion, such as minimally invasive (MIS) or robotic-assisted spine surgery. However, it is unknown how these advances have impacted the cost of care. PURPOSE: Compare the economic outcomes of lumbar spine fusion between open, MIS, and robot-assisted surgery patients. STUDY DESIGN/SETTING: Retrospective review of a single center spine surgery database. FDA device/drug status: Not applicable. Author disclosures: PGP: Allosource: Other financial or material support; Cervical Scoliosis Research Society: Research support; Globus Medical: Paid presenter or speaker; Medicrea: Paid consultant; Royal Biologics: Paid consultant; SpineWave: Paid consultant; Terumo: Paid consultant; Zimmer: Paid presenter or speaker. AEB: Nothing to disclose. HA: Nothing to dis- close. CAB: Nothing to disclose. KEP: Nothing to disclose. HH: 4Web: Stock or stock Options; DePuy, A Johnson & Johnson Company: Paid con- sultant; Globus Medical: Paid presenter or speaker; Medtronic: Paid consul- tant; Paid presenter or speaker; Research support; Misonix: Stock or stock Options; Norvartis: Stock or stock Options; Nuvasive: Paid consultant; Paid presenter or speaker; Stock or stock Options; Orthofix, Inc.: Paid presenter or speaker; Research support; Pacira: Stock or stock Options; Pfizer: Paid consultant; Research support; Scoliosis Research Society: Board or commit- tee member. LAL: Nothing to disclose. VP: Nothing to disclose. DVM: Nothing to disclose. EW: Nothing to disclose. RCI: Nothing to disclose. BGD: Nothing to disclose. VL: DePuy, A Johnson & Johnson Company: Paid presenter or speaker; European Spine Journal: Editorial or governing board; Globus Medical: Paid consultant; International Spine Study Group: Board or committee member; Nuvasive: IP royalties; Scoliosis Research Society: Board or committee member; The Permanente Medical Group: Paid presenter or speaker. RL: Nemaris: Stock or stock Options. DMS: Baxter: Paid consultant; DePuy, A Johnson & Johnson Company: Paid con- sultant; K2M: Paid consultant; Medtronic: Paid consultant; Nuvasive: Paid consultant; Stryker: Paid consultant. MBJ: Nothing to disclose. TSP: Altus: IP royalties; Globus Medical: Paid consultant; Medicrea: Paid consultant; Nuvasive: Paid consultant; Spine Align: Stock or stock Options; Stryker: Paid consultant; Torus Medical: Stock or stock Options. AJB: Nuvasive: Paid consultant; Stryker: Paid consultant. MCG: AAOS: Board or commit- tee member; Cervical Spine Research Society: Board or committee member; CTL Medical: Other financial or material support; Integrity Implants: Paid consultant; Integrity Implants, Inc: IP royalties; RTI Surgical: Paid consul- tant; Wolf Endoscopic: Paid consultant. Funding: No funding was received in relation to the creation of this work. Conflicts of Interest: Peter G Passias MD - Reports personal consulting fees for Spinewave, Zimmer Biomet, DePuy Synthes, and Medicrea out- side the submitted work. *Corresponding author. Peter G. Passias, MD, Division of Spinal Sur- gery/Departments of Orthopaedic and Neurosurgery, NYU Medical Cen- ter, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA, Tel.: (516) 357-8777, fax: (516) 357-0087. E-mail address: peter.passias@nyumc.org (P.G. Passias). https://doi.org/10.1016/j.spinee.2020.10.012 1529-9430/© 2020 Published by Elsevier Inc. ARTICLE IN PRESS The Spine Journal 000 (2020) 1-9