title: Increased Utilization of Cervical Disk Arthroplasty in University Hospitals with Regional Variation and Socioeconomic Discrepancies.
abstract: OBJECTIVE
  Treatment of cervical radiculopathy with disk arthroplasty has been approved by the U.S. Food and Drug Administration since 2007. Recently, a significant increase in clinical data including mid- and long-term follow-up has become available, demonstrating the superiority of disk arthroplasty compared with anterior discectomy and fusion. The aim of this project is to assess the nationwide use of cervical disk arthroplasty.
  
  
  METHODS
  The University Healthcare Consortium database was accessed for all elective cases of patients treated for cervical radiculopathy caused by disk herniation (International Classification of Diseases [ICD] 722.0) from the fourth quarter of 2012 to the third quarter of 2015. Within this 3-year window, temporal and socioeconomic trends in the use of cervical disk replacement for this diagnosis were assessed.
  
  
  RESULTS
  Three thousand four hundred forty-six cases were identified. A minority of cases (10.7%) were treated with disk arthroplasty. Median hospital charges were comparable for cervical disk replacement ($15,606) and anterior cervical fusion ($15,080). However, utilization was seen to increase by nearly 70% during the timeframe assessed. Disk arthroplasty was performed in 8% of patients in 2012 to 2013, compared with 13% of cases in 2015. Disk replacement use was more common for self-paying patients, patients with private insurance, and patients with military-based insurance. There was widespread variation in the use of cervical disk replacement between regions, with a nadir in northeastern states (8%) and a peak in western states (20%).
  
  
  CONCLUSIONS
  Over a short, 3 -year period there has been an increase in the treatment of symptomatic cervical radiculopathy with disk arthroplasty. The authors predict a further increase in cervical disk arthroplasty in upcoming years.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: Sheri K
authors.initials: SK
authors.lastname: Palejwala
authors.affiliation: Maine Medical Partners, Neurosurgery and Spine, Scarborough, Maine, USA.
authors.forename: Anand I
authors.initials: AI
authors.lastname: Rughani
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA. Electronic address: tdumont@surgery.arizona.edu.
authors.forename: Travis M
authors.initials: TM
authors.lastname: Dumont
mesh_terms: D001178:Arthroplasty / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D002574:Cervical Vertebrae / Q000601:surgery*; D016208:Databases, Factual; D017586:Diskectomy / Q000191:economics / Q000706:statistics & numerical data*; D005843:Geography; D054625:Healthcare Disparities; D017722:Hospital Charges; D006785:Hospitals, University; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery*; D012923:Social Class; D013123:Spinal Fusion / Q000191:economics / Q000706:statistics & numerical data*; D059145:Total Disc Replacement / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends
keywords: Cervical arthroplasty; Cervical fusion; Cervical radiculopathy; Disk herniation; Disk replacement