100 patients with chronic low back pain were randomized to undergo either transforaminal lumbar interbody fusion (TLIF) or posterolateral fusion (PLF). The purpose of the current study was to evaluate the cost-utility and cost-efficacy of TLIF relative to PLF. Data on primary health care costs, secondary health care costs, and production loss costs over the first 2 postoperative years were used for the analysis. Overall, no significant differences in costs were noted between groups, although total cost was higher with TLIF (59863€ vs. 55200€). As clinical outcome was found to not differ, cost-effective acceptability curves using QALYs and the Oswetry Disability Index did not demonstrate cost-effectiveness of TLIF compared to PLF.