Patient Information Resources

Spine Institute
Glendale Adventist Medical Center
1500 E. Chevy Chase Drive, Suite 401B
Glendale, CA 91206
Ph: (818) 863-4444

Spine - Cervical
Spine - General
Spine - Lumbar
Spine - Thoracic

View Web RX

« Back

Comparing Cost Effectiveness and Outcomes Between ACDF and CDR

Posted on: 09/24/2015
The gold standard of treatment for symptoms including long term neck pain, neurological deficits and radiculopathy stemming from the degenerative changes of the neck is an anterior cervical discectomy and fusion (ACDF). It has a very high clinical success rate but is also associated with some negative long term side-effects including loss of cervical range of motion, increased degenerative changes at segments adjacent to the fusion level and an increased reliance on future need to solid bony fusion. An alternative to ACDF was developed for this reason. A cervical disc replacement (CDR) procedure can result in symptomatic relief while preserving range of motionand decreasing degeneration at adjacent segments.

A recent group of large randomized clinical studies investigated long term outcomes comparing ACDF to CDR. They looked at measures including perceived neck function, general health, neurologic improvement and avoidance of future secondary surgical needs. All reported improvement in all outcomes with both CDR and ACDF, with no significant difference between to two procedures. Since CDR is just as beneficial as ACDF but does not come with secondary side effects such as loss of range of motion and increased risk of future deterioration of adjacent segments, it may be the new ‘gold standard’, however another important variable to consider is cost-effectiveness, both short and long term.

Utilizing a patient population targeting individuals over the age of 40 with acute disc herniation and associated radiculopathy, ACDF and CDR were compared with 6 possible outcomes of each procedure: well after primary surgery, nonoperative complication, well after revision, complication after revision, adjacent segment revision, and death. Transitions between the above listed health states were estimated from current literature which included seven studies and over one-thousand total patients. Estimated costs in dollars for each procedure were generated using 2010 Medicare reimbursements for 2010 and quality-adjusted life years (QALYs), were also estimated .

The study found that CDR generated a five year total cost of $102,274, compared to ACDF total cost of $119,814. Furthermore, CDR resulted in 2.84 QALYs while ACDF generated 2.81 QALYs. The cost-effectiveness ratio using these two measures was $35,976/QALY for cervical disc replacement and $42,618/QALY for anterior cervical discectomy and fusion. CDR is less costly and more effective when compared results in a 5 year follow-up span.

McAnany et al. The 5-Year Cost Effectiveness of Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement. In Spine. 2014. Vol. 39. No. 23. Pp 1924-1933.

« Back

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.