Introduction: Cervical radiculopathy remains highly prevalent and costly in the U.S. healthcare system. While ACDF has remained the most
popular surgical treatment modality, minimally invasive advancements such as posterior micro-endoscopic
discectomy/foraminotomy(pMED) has emerged as a motion preserving and less invasive alternative. To date, the comparative effectiveness and cost-effectiveness of pMED vs. ACDF remains unclear.
Methods: Patients undergoing surgery for single-level radiculopathy without
myelopathy resulting from foraminal stenosis or foraminal disc
herniation without instability over a one-year period were
prospectively enrolled into an institutional database. Baseline, post
-operative 3-months, and 12-months VAS-Arm and Neck, NDI, EQ
-5D, and return to work(RTW) status were collected. Direct
healthcare cost(payer perspective) and indirect cost (work-day
losses multiplied by median gross-of-tax wage and benefits rate)
was assessed.
Results: Total 20 ACDF and 28 pMED patients were identified. Baseline
demographics, symptomatology, and co-morbidities were similar
between the cohorts. For pMED vs. ACDF, mean length of surgery
(48.1±20.0 vs. 69.9±11.6 minutes, p<0.0001) and estimated blood
loss (20.3±9.3 vs. 31.8±15.4 mL,p=0.04) was reduced. There was
no 90-day morbidity or re-admission for either cohort. One(3.6%)
pMED patient required a subsequent ACDF; no patients in the
ACDF cohort required re-operation by one-year. pMED and ACDF
cohorts demonstrated similar improvement in arm-VAS(3.1 vs.
2.6,p=0.66), neck-VAS(2.0 vs. 3.2,p=0.24), NDI(9.0 vs.
6.8,p=0.24), and EQ-5D(0.17 vs. 0.15,p=0.82). Ability to
RTW(93.8% vs. 94.1%,p=1.0) and median time to RTW(3.7[0.9-
8.1] vs. 3.6[2.1-8.5] weeks,p=0.85) were similar. pMED was
associated with significantly reduced direct cost(p>0.001) but
similar indirect cost(p=0.43), resulting in an average total cost
savings of $7,689(p<0.01) per case with similar QALY-gain (0.17
vs. 0.15,p=0.82).
Conclusions: For single-level unilateral-radiculopathy resulting from foraminal
stenosis or lateral disc herniation without segmental instability,
pMED was equivalent to ACDF in safety and effectiveness. pMED
represents a minimally invasive, motion preserving alternative to
select patients with cervical radiculopathy without the need for
implant costs with concomitant significant cost saving.
Patient Care: pMED represents a minimally invasive, motion preserving
alternative to select patients with cervical radiculopathy without the
need for implant costs with concomitant significant cost saving.
Learning Objectives: The comparative-effectiveness and cost-effectiveness research
have emerged as an important tool to determine value of spine
care by merging patient-centered outcomes with responsible use
of societal health care resources. To date, the comparative
effectiveness and cost effectiveness of pMED vs. ACDF remains
unclear. In this study, we demonstrate that for single-level
unilateral-radiculopathy resulting from foraminal stenosis or lateral
disc herniation without segmental instability, pMED was equivalent
to ACDF in safety and effectiveness, however pMED had
significant cost saving benefit compared to ACDF.