Buttermann G, et al. - Experts contrasted the clinical and economic outcomes of facet compared with pedicle screw instrumentation for single-level circumferential lumbar spinal fusion. For both groups, clinical betterment was important from pre-op to 10-year follow-up. At all follow-up periods > 1 year, outcomes were markedly superior for back pain and ODI for the facet vs pedicle group. In the CEA base-case, in comparison with pedicle screws, facets had more QALYs and lower costs (− $8,650) per person. Hence, facets were dominant (ie, given cost savings and greater QALYs) vs pedicle screws. Facets had a 97% likelihood of being under a willingness-to-pay threshold of $20,000 per QALY gained and were expected to be powerful in 84% of the simulations, over pedicle screws. Thus, using facet screws, one-level circumferential spinal fusion was clinically better and given cost savings in comparison with pedicle screw instrumentation in the USA.