Cervical disc arthroplasty has higher preoperative costs than anterior cervical discectomy and fusion: a retrospective analysis.

PURPOSE: To assess and compare the preoperative healthcare costs associated with single-level cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF), with additional evaluation across cost categories and insurance types.

METHODS

Patients who underwent CDA or ACDF between 2010 and 2022 were queried from the PearlDiver Mariner database. Preoperative expenditures - including office visits, imaging (X-ray, MRI, CT), opioid prescriptions, steroid injections, and physical therapy - were quantified. Patients were stratified by insurance type, and statistical comparisons were performed using t-tests with significance set at P < 0.05.

RESULTS

CDA was associated with significantly higher preoperative costs compared to ACDF. The mean total preoperative cost for CDA was $10,967.98 versus $9,463.64 for ACDF (P < 0.001), driven by greater expenditures on physical therapy, imaging, and office visits. Among Medicare beneficiaries, CDA patients had preoperative costs of $9,517.83 versus $9,178.40 for ACDF (P < 0.001), with significant differences in imaging. In the commercial insurance cohort, CDA patients incurred $11,062.86 compared to $9,226.20 for ACDF (P < 0.001), with larger differences in physical therapy, imaging, and office visits.

CONCLUSION

CDA incurs higher preoperative costs than ACDF across both Medicare and commercial insurance groups, with notable differences in physical therapy and imaging expenditures. These findings underscore the importance of evaluating cost drivers in the preoperative setting and highlight the potential for cost-optimization strategies, particularly in patients undergoing CDA.