Treatment of cervical radiculopathy: A review of the evolution and economics

Jared D Ament; Tejas Karnati; Edwin Kulubya; Kee D Kim; J Patrick Johnson

doi:10.4103/sni.sni_441_17

Treatment of cervical radiculopathy: A review of the evolution and economics

Surg Neurol Int. 2018 Feb 14:9:35. doi: 10.4103/sni.sni_441_17. eCollection 2018.

Authors

Jared D Ament^{1

2}, Tejas Karnati¹, Edwin Kulubya¹, Kee D Kim¹, J Patrick Johnson^{1

2}

Affiliations

¹ Department of Neurological Surgery, University of California, Sacramento, California, USA.
² The Spine Surgery Institute, Cedars Sinai Medical Center, Los Angeles, California, USA.

Abstract

Background: The surgical treatment of cervical radiculopathy has centered around anterior cervical discectomy and fusion (ACDF). Alternatively, the posterior cervical laminoforaminotomy/microdiscectomy (PCF/PCM), which results in comparable outcomes and is more cost-effective, has been underutilized.

Methods: Here, we compared the direct/indirect costs, reoperation rates, and outcome for ACDF and PCF vs. PCM using PubMed, Medline, and Embase databases.

Results: There were no significant differences between the re-operative rates of PCF/PCM (2% to 9.8%) versus ACDF (2% to 8%). Direct costs of ACDF were also significantly higher; the 1-year cost-utility analysis demonstrated that ACDF had $131,951/QALY while PCM had $79,856/QALY.

Conclusion: PCF/PCM for radiculopathy are safe and more cost-effective vs. ACDF, and have similar clinical outcomes.

Keywords: Cervical degenerative disc disease; cervical disc herniation; cost-effectiveness; posterior approach; posterior cervical microdiscectomy; quality of life.