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  • Posterior Micro-Endoscopic Discectomy vs. ACDF for Single-level Radiculopathy: Comparative Effectiveness and Cost-Utility Analysis

    Final Number:
    182

    Authors:
    Matthew J. McGirt MD; E. Hunter Dyer MD; Domagoj Coric MD; Silky Chotai MD; Anthony L. Asher MD FACS; Tim E. Adamson MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    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.

    References:

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