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

  • Blake N. Staub
  • Todd J. Albert
Chapter

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.

Keywords

Value Cost Quality ICER QALY 

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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. 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. 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. 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. 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.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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. 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

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Blake N. Staub
    • 1
  • Todd J. Albert
    • 2
  1. 1.Texas Back InstitutePlanoUSA
  2. 2.Hospital for Special SurgeryNew YorkUSA

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