title: Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis.
abstract: OBJECTIVE
  Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs.
  
  
  METHODS
  After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery.
  
  
  RESULTS
  The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status.
  
  
  CONCLUSIONS
  In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.
authors.affiliation: Departments of Neurological Surgery and.
authors.forename: Haley E
authors.initials: HE
authors.lastname: Mansfield
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Canar
authors.forename: Carter S
authors.initials: CS
authors.lastname: Gerard
authors.forename: John E
authors.initials: JE
authors.lastname: O'Toole
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D017586:Diskectomy / Q000191:economics*; D005260:Female; D059526:Foraminotomy / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACDF = anterior cervical discectomy and fusion; BMI = body mass index; LOS = length of stay; PCF = posterior cervical foraminotomy; anterior cervical discectomy and fusion; cervical radiculopathy; minimally invasive posterior cervical foraminotomy