Journal of spine surgery (Hong Kong) · 2026
Cost-effectiveness of three-level cervical disc arthroplasty vs. anterior discectomy and fusion: a comparative single-system analysis.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Hoglund Zachary T, Kathawate Varun G, Sollenberger Christopher S, Wu Albert Q, Englander Raphael, Rani Neha, Saadoun Jacob, Massaad Elie, Schuster James M, Marcotte Paul J, Shammassian Berje H, Welch William C, Casper David S, Ozturk Ali K, Ali Zarina S, Malhotra Neil R, Shin John H, Judy Brendan F
Аннотация
BACKGROUND: Cervical degenerative disc disease is a common indication for surgical intervention to stabilize vertebral segments and alleviate symptomatic radiculopathy or myelopathy. While anterior cervical discectomy and fusion (ACDF) has long been a standard procedure for these cases, more recently, cervical disc arthroplasty (CDA) has offered a motion preserving alterative to potentially reduce adjacent segment degeneration (ASD). Although cost-effectiveness data exist for single- and two-level procedures, there remain no direct comparisons for three-level CDA constructs. This study retrospectively evaluates admission costs and 3-month clinical outcomes between three-level CDA and ACDF to evaluate each procedure's relative cost-effectiveness.
METHODS: In this single-system retrospective study, patients receiving elective three-level CDA (n=10) or ACDF (n=10) for degenerative cervical pathology were compared. Exclusion criteria included acute trauma, infection, or tumors. Data collected included patient demographics, comorbidities, symptoms, radiological findings, procedural details, postoperative complications, and 3-month clinical outcomes. Financial metrics, normalized to institutional cost units, included total admission costs and subcategories [e.g., equipment cost, operating room (OR) cost]. Statistical comparisons employed Kruskal-Wallis and chi-square tests (P<0.05 threshold).
RESULTS: Cohorts exhibited comparable baseline characteristics, including age (CDA: 52.3±9.6 years; ACDF: 58.7±7.4 years), comorbidities, symptoms, and diagnoses (P>0.05). Operative times trended longer for CDA (268.6±40.7 min) vs. ACDF (222.8±84.4 min; P=0.08). No intraoperative complications occurred in either cohort, and postoperative complications were not significantly higher for CDA vs. ACDF (30% vs. 10%; P=0.58). There were no significant differences in 3-month symptom resolution and readmission/reoperation rates between procedures (P>0.40). Total admission costs were markedly elevated for CDA (78.04 units) compared to ACDF (46.25 units; +68.75%, P<0.001), driven predominantly by equipment costs (+152.34%, P<0.001), with lesser increases in OR (+32.97%, P=0.006), anesthesia (+56.0%, P=0.008), and radiology costs (+74.56%, P=0.005).
CONCLUSIONS: Three-level CDA incurs substantially higher admission costs than ACDF without short-term clinical superiority. These findings highlight equipment-driven cost differences amid comparable clinical efficacy, suggesting ACDF may be superior to CDA in three-level cases where motion preservation is not essential and cost is a significant consideration. However, further cost-utility analyses are necessary to evaluate how differences in long-term ASD rates and reoperations may compensate for the higher short-term admission costs of CDA.
METHODS: In this single-system retrospective study, patients receiving elective three-level CDA (n=10) or ACDF (n=10) for degenerative cervical pathology were compared. Exclusion criteria included acute trauma, infection, or tumors. Data collected included patient demographics, comorbidities, symptoms, radiological findings, procedural details, postoperative complications, and 3-month clinical outcomes. Financial metrics, normalized to institutional cost units, included total admission costs and subcategories [e.g., equipment cost, operating room (OR) cost]. Statistical comparisons employed Kruskal-Wallis and chi-square tests (P<0.05 threshold).
RESULTS: Cohorts exhibited comparable baseline characteristics, including age (CDA: 52.3±9.6 years; ACDF: 58.7±7.4 years), comorbidities, symptoms, and diagnoses (P>0.05). Operative times trended longer for CDA (268.6±40.7 min) vs. ACDF (222.8±84.4 min; P=0.08). No intraoperative complications occurred in either cohort, and postoperative complications were not significantly higher for CDA vs. ACDF (30% vs. 10%; P=0.58). There were no significant differences in 3-month symptom resolution and readmission/reoperation rates between procedures (P>0.40). Total admission costs were markedly elevated for CDA (78.04 units) compared to ACDF (46.25 units; +68.75%, P<0.001), driven predominantly by equipment costs (+152.34%, P<0.001), with lesser increases in OR (+32.97%, P=0.006), anesthesia (+56.0%, P=0.008), and radiology costs (+74.56%, P=0.005).
CONCLUSIONS: Three-level CDA incurs substantially higher admission costs than ACDF without short-term clinical superiority. These findings highlight equipment-driven cost differences amid comparable clinical efficacy, suggesting ACDF may be superior to CDA in three-level cases where motion preservation is not essential and cost is a significant consideration. However, further cost-utility analyses are necessary to evaluate how differences in long-term ASD rates and reoperations may compensate for the higher short-term admission costs of CDA.