Comparison of Anterior Cervical Discectomy and Fusion to Posterior Cervical Foraminotomy for Cervical Radiculopathy: Utilization, Costs, and Adverse Events 2003 to 2014

BACKGROUND: Surgery for cervical radiculopathy is often approached by either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). ACDF is more common; however, recent single center studies suggest comparable efficacy and significant cost savings with PCF in appropriately selected patients. OBJECTIVE: To compare utilization, adverse events, and costs for each approach from a national perspective. METHODS: Adults undergoing single level ACDF or PCF for cervical radiculopathy were included from a US commercial health insurance claims database spanning 2003 to 2014. Outcomes consisted of mortality, adverse events, length of stay, and total payments to the health provider. Propensity score matching balanced the groups on observed baseline covariates. RESULTS: The PCF cohort comprised 4851 subjects and the ACDF cohort included 46147. A greater proportion of PCF cases were discharged on the same day (70.6% vs 46.1%; P < .001). Mortality (0.1/1000, P = .012), vascular injury (0.2/1000, P = .001), postoperative dysphagia/dysphonia (14.5/1000, P < .001), cutaneous cerebrospinal fluid leak (0.2/1000, P = .002), and deep venous thrombosis (0.9/1000, P = .013) occurred more frequency in the ACDF cohort. Conversely, wound infections (14.6/1000, P < .001) and 30-d readmissions (9.8/1000, P < .001) were more frequent in the PCF cohort. Mean unadjusted total payments for the PCF cohort were $15281 +/- 12225 and $26849 +/- 16309 for ACDF. Matched difference was -$11726 [95% confidence interval: -$12221, -$11232, P < .001] favoring PCF. CONCLUSION: Within the inherent limitations of administrative data, our findings suggest an opportunity for value improvement in managing cervical radiculopathy and indicate a need for large-scale comparative study of clinical outcomes and costs.