Skip to main content
SpringerLink
Log in

The Cost-Effectiveness of Various Surgical Procedures in the Cervical Spine

  • Chapter
  • First Online:
Degenerative Cervical Myelopathy and Radiculopathy

  • 1349 Accesses

Abstract

The cost of healthcare and spine surgery, in particular, continues to rise. The ever-increasing volume of spine surgery being performed, as well as the use of instrumentation, biologics, and advanced technology, keeps shifting the cost curve upward. The value of healthcare is defined as the overall quality of care provided divided by the cost. Cervical radiculopathy and myelopathy can be effectively treated via numerous surgical interventions – all with proven quality – but, sometimes, with very different costs. All medical interventions should not only be scrutinized for their success rates but also for their overall value. Anterior cervical discectomies and fusions, cervical disc replacements, and posterior cervical foraminotomies are all valuable surgical options for the treatment of one-level cervical radiculopathy. However, there is a trend in the literature to suggest that, in properly indicated patients, CDRs and PCFs potentially provide a greater value to the patient. The treatment of degenerative cervical myelopathy has been shown to be extremely valuable regardless of the surgical approach used. Additionally, current data implies that the use of outpatient surgical centers should be considered in an effort to reign in the overall costs of cervical spine surgery. There are numerous options in the treatment of the degenerative cervical spine. Given the economic costs of modern healthcare, it is imperative that surgeons examine the value of these specific treatments as opposed to simply focusing on the quality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299(6):656–64.

    Article  CAS  Google Scholar 

  2. Nwachukwu BU, Hamid KS, Bozic KJ. Measuring value in orthopaedic surgery. JBJS Rev. 2013;1(1) https://doi.org/10.2106/JBJS.RVW.M.00067.

    Article  Google Scholar 

  3. Grosse SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008;8(2):165–78.

    Article  Google Scholar 

  4. Adamson T, Godil SS, Mehrlich M, Mendenhall S, Asher AL, McGirt MJ. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases. J Neurosurg Spine. 2016;24(6):878–84.

    Article  Google Scholar 

  5. Silvers HR, Lewis PJ, Suddaby LS, Asch HL, Clabeaux DE, Blumenson LE. Day surgery for cervical microdiscectomy: is it safe and effective? J Spinal Disord. 1996;9(4):287–93.

    Article  CAS  Google Scholar 

  6. McClelland S 3rd, Oren JH, Protopsaltis TS, Passias PG. Outpatient anterior cervical discectomy and fusion: a meta-analysis. J Clin Neurosci. 2016;34:166–8.

    Article  Google Scholar 

  7. Goz V, Rane A, Abtahi AM, Lawrence BD, Brodke DS, Spiker WR. Geographic variations in the cost of spine surgery. Spine (Phila Pa 1976). 2015;40(17):1380–9.

    Article  Google Scholar 

  8. Carreon LY, Anderson PA, Traynelis VC, Mummaneni PV, Glassman SD. Cost-effectiveness of single-level anterior cervical discectomy and fusion five years after surgery. Spine (Phila Pa 1976). 2013;38(6):471–5.

    Article  Google Scholar 

  9. Qureshi SA, McAnany S, Goz V, Koehler SM, Hecht AC. Cost-effectiveness analysis: comparing single-level cervical disc replacement and single-level anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine. 2013;19(5):546–54.

    Article  Google Scholar 

  10. McAnany SJ, Overley S, Baird EO, et al. The 5-year cost-effectiveness of anterior cervical discectomy and fusion and cervical disc replacement: a markov analysis. Spine (Phila Pa 1976). 2014;39(23):1924–33.

    Article  Google Scholar 

  11. Radcliff K, Zigler J, Zigler J. Costs of cervical disc replacement versus anterior cervical discectomy and fusion for treatment of single-level cervical disc disease: an analysis of the blue health intelligence database for acute and long-term costs and complications. Spine (Phila Pa 1976). 2015;40(8):521–9.

    Article  Google Scholar 

  12. Ament JD, Yang Z, Nunley P, Stone MB, Kim KD. Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease. JAMA Surg. 2014;149(12):1231–9.

    Article  Google Scholar 

  13. Warren D, Andres T, Hoelscher C, Ricart-Hoffiz P, Bendo J, Goldstein J. Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: a single-center contribution to the randomized controlled trial. Int J Spine Surg. 2013;7:e58–66.

    Article  Google Scholar 

  14. Ament JD, Yang Z, Nunley P, Stone MB, Lee D, Kim KD. Cost utility analysis of the cervical artificial disc vs fusion for the treatment of 2-level symptomatic degenerative disc disease: 5-year follow-up. Neurosurgery. 2016;79(1):135–45.

    Article  Google Scholar 

  15. Ghori A, Konopka JF, Makanji H, Cha TD, Bono CM. Long term societal costs of anterior discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for treatment of cervical radiculopathy. Int J Spine Surg. 2016;10:1.

    Article  Google Scholar 

  16. Mansfield HE, Canar WJ, Gerard CS, O’Toole JE. Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus. 2014;37(5):E9.

    Article  Google Scholar 

  17. Tumialan LM, Ponton RP, Gluf WM. Management of unilateral cervical radiculopathy in the military: the cost effectiveness of posterior cervical foraminotomy compared with anterior cervical discectomy and fusion. Neurosurg Focus. 2010;28(5):E17.

    Article  Google Scholar 

  18. Bydon M, Mathios D, Macki M, et al. Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases. J Neurosurg Spine. 2014;21(5):727–31.

    Article  Google Scholar 

  19. Witiw CD, Tetreault LA, Smieliauskas F, Kopjar B, Massicotte EM, Fehlings MG. Surgery for degenerative cervical myelopathy: a patient-centered quality of life and health economic evaluation. Spine J. 2016;16:S231.

    Article  Google Scholar 

  20. Fehlings MG, Jha NK, Hewson SM, Massicotte EM, Kopjar B, Kalsi-Ryan S. Is surgery for cervical spondylotic myelopathy cost-effective? A cost-utility analysis based on data from the AOSpine north america prospective CSM study. J Neurosurg Spine. 2012;17(1 Suppl):89–93.

    Article  Google Scholar 

  21. Cunningham MR, Hershman S, Bendo J. Systematic review of cohort studies comparing surgical treatments for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2010;35(5):537–43.

    Article  Google Scholar 

  22. Ghogawala Z, Martin B, Benzel EC, et al. Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery. 2011;68(3):622–30; discussion 630-1.

    Article  Google Scholar 

  23. Whitmore RG, Schwartz JS, Simmons S, Stein SC, Ghogawala Z. Performing a cost analysis in spine outcomes research: comparing ventral and dorsal approaches for cervical spondylotic myelopathy. Neurosurgery. 2012;70(4):860–7; discussion 867.

    Article  Google Scholar 

  24. Liu T, Yang HL, Xu YZ, Qi RF, Guan HQ. ACDF with the PCB cage-plate system versus laminoplasty for multilevel cervical spondylotic myelopathy. J Spinal Disord Tech. 2011;24(4):213–20.

    Article  Google Scholar 

  25. Nunley P, Kerr E, et al. Clinical implications of heterotopic ossification after cervical disc arthroplasty. In: Forty-fourth annual meeting of the Cervical Spine Research Society. 2016.

    Google Scholar 

  26. Marques C, MacDowall A, et al. Unintended fusion in cervical artifical disc replacement: a prospective study on heterotopic ossification with 5 years follow-up. In: Forty-fourth annual meeting of the Cervical Spine Research Society. 2016.

    Google Scholar 

  27. Zhou F, Ju K, et al. Progressive bone formation after cervical disc replacement: a 5-year follow-up. In: Forty-fourth annual meeting of the Cervical Spine Research Society. 2016.

    Google Scholar 

  28. Skeppholm M. Elevated risk for repeated surgery after ADR compared to ACDF in a cohort of 715 patients – a retrospective study with minimum five-year follow-up. In: Forty-fourth annual meeting of the Cervical Spine Research Society. 2016.

    Google Scholar 

  29. Alvin MD, Qureshi S, Klineberg E, et al. Cervical degenerative disease: systematic review of economic analyses. Spine (Phila Pa 1976). 2014;39(22 Suppl 1):S53–64.

    Article  Google Scholar 

  30. Campbell MJ, Carreon LY, Traynelis V, Anderson PA. Use of cervical collar after single-level anterior cervical fusion with plate: is it necessary? Spine (Phila Pa 1976). 2009;34(1):43–8.

    Article  Google Scholar 

  31. Miller J, Sasso R, et al. Adjacent-level degeneration after Bryan cervical disc arthroplasty compared with anterior discectomy and fusion. In: Forty-fourth annual meeting of the Cervical Spine Research Society. 2016.

    Google Scholar 

  32. MacDowall A, Canto Moreia N, et al. Artifical disc replacements do not prevent adjacent segment degeneration in the cervical spine. In: Forty-fourth annual meeting of the Cervical Spine Research Society. 2016.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Texas Back Institute, Plano, TX, USA

    Blake N. Staub

  2. Hospital for Special Surgery, New York, NY, USA

    Todd J. Albert

Authors
  1. Blake N. Staub
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Todd J. Albert
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Columbia University Medical Center, New York, NY, USA

    Michael G. Kaiser

  2. Atlanta Brain and Spine Care, Atlanta, GA, USA

    Regis W. Haid

  3. Duke University Health System, Durham, NC, USA

    Christopher I. Shaffrey

  4. Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Michael G. Fehlings

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Staub, B.N., Albert, T.J. (2019). The Cost-Effectiveness of Various Surgical Procedures in the Cervical Spine. In: Kaiser, M., Haid, R., Shaffrey, C., Fehlings, M. (eds) Degenerative Cervical Myelopathy and Radiculopathy . Springer, Cham. https://doi.org/10.1007/978-3-319-97952-6_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97952-6_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97951-9

  • Online ISBN: 978-3-319-97952-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation