Endoscopic Spine Surgery: Distance Patients Will Travel for Minimally Invasive Spine Surgery

Background: Transforaminal lumbar endoscopic discectomy is a minimally invasive spine surgery procedure performed principally for the treatment of lumbar herniated discs. Endoscopic spine surgeons around the world have noted how far patients will travel to undergo this minimally invasive spine surgery, but the actual distance patients travel has never been investigated. Objective: We present here our analysis of how far patients will travel for endoscopic spine surgery by studying the referral patterns of patients to 3 centers in 3 different countries. Study Design: Retrospective chart review of de-identified patient data was performed to analyze the distance patients travel for spine surgery. Methods: Patient demographic data was analyzed for patients undergoing transforaminal lumbar endoscopic discectomy procedures over the same 8 month period in 2015 at centers in the United States (U.S.), Netherlands, and Germany. Results: Travel distances for patients were determined for 327 patients. The average distance traveled for the U.S. center was 91 miles, the Dutch center was 287 miles, and the German center was 103 miles. For the U.S. center 16% of patients traveled out of state for surgery and for the European centers combined, 4% of patients traveled out of the country for surgery. Limitations: The period of data analyzed was less than one year and the data collected was analyzed retrospectively. Conclusions: Quality metrics in health care tend to be focused on how health care is delivered. Another health care metric that focuses more on what patients desire is presented here: how far patients will travel for innovative spine care. Key words: Endoscopic spine surgery, transforaminal, minimally invasive, travel, lumbar disc herniation