Rediscovering Posterior Cervical Foraminotomy/Diskectomy With the Endoscope: A Favorable Cost Comparison with the Traditional Treatment of a Cervical Radiculopathy.

BACKGROUND AND

OBJECTIVES

If nonoperative therapy fails, a unilateral cervical radiculopathy has traditionally been treated with anterior cervical diskectomy and fusion or posterior cervical foraminotomy/diskectomy. More recently, full-endoscopic posterior cervical foraminotomy/diskectomy (FEPCF) has gained popularity. In a cohort of patients with isolated, unilateral cervical radiculopathy, we sought to conduct a preliminary, pilot study to compare the total cost of surgical care between open and endoscopic posterior foraminotomy/diskectomy.

METHODS

A single-center, retrospective, cohort study of patients undergoing open or FEPCF between 2016 and 2023. Initial surgical costs (not Medicare reimbursement or charges) were adjusted to 2023 US dollars. Perioperative outcomes were recorded. Multivariable analysis tested sex, body mass index, age, insurance type, race, length of stay (LOS), and operation length's potential impact on cost. Sensitivity and break-even analyses were also performed.

RESULTS

A total of 15 open and 15 FEPCF were performed. Baseline demographics and medical comorbidities were equivalent. Cost (mean ± 95% CI) was 41.5% higher in the open cohort ($14 231 ± $1297 vs $10 057 ± $755, P < .001) driven by the open foraminotomy/diskectomy operation (β = $3386, P = .001) and LOS (β = $1768/day, P = .008) on multivariable analysis. Sensitivity analysis showed low likelihood of any variable making open foraminotomy/diskectomy as cost efficient as the endoscopic technique, and an endoscopic failure rate of 29.7% would be required for equipoise between the approaches. Surgical length (mean ± SD) was similar (158.8 ± 49.9, 140.3 ± 28.2 minutes, P = .224), but LOS (0.9 ± 0.8 vs 0.1 ± 0.2 days, P < .001) was higher in the open compared with the endoscopic cohort. There was equivalent 6-week neurological improvement without statistical difference in complications, reoperations, or readmissions. None of the endoscopic cohort required narcotics postoperatively.

CONCLUSION

In a cohort of patients with isolated, unilateral cervical radiculopathy, FEPCF was a significantly less costly alternative with equivalent short-term outcomes compared with the traditional open technique. These findings may help patients and surgeons revisit the endoscope as a less costly, motion-preserving alternative.