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Which Surgery is Better, a Neck Fusion or a Cervical Disc Replacement? An Economic Evaluation of Their Respective Cost-Effectiveness Five Years Later

Persistent neck pain with radiating upper back pain, arm pain and/or weakness is a fairly common and serious problem with the aging neck in the United States. Advanced degenerative disc and joint disease or the disease process of serious ‘wear and tear’ of the upper human spine, often does not cause significant limitations nor require surgery. However, some people have enough neck pain or severe weakness in the nerves of the arm/hand that does not respond to typical, conservative medical care. The "gold standard" surgery for treating these stubborn and severe neck issues historically has been an anterior cervical discectomy and fusion (a fusion of the problematic neck joints and trimming of the bulging disc). However, despite this surgery’s long-term success rate for effectively improving the pain and arm weakness, it has it’s drawbacks. Neck fusions can create more problems on the nearby joints that were not fused and rely heavily on a solid bone to bone fusion to be effective.

These challenges with the anterior cervical discectomy and fusion surgery have motivated surgeons to attempt an improved surgery known as a cervical disc replacement. Similar to replacing a hip or knee, the bulging and worn disc(s) are removed and an artificial disc is placed. This disc replacement alternative surgery is in theory supposed to reduce speed of the fusion creating more problems on the nearby healthier discs and restore normal neck joint motions. Enter Dr. McAnany and his team of researchers at Mount Sinai Medical Center in New York that were determined to find out which operation was most cost-effective five years following the surgery date.

This study compared the two different surgeries for the same neck disease using best estimates of cost, multiple outcome surveys on how the patients were recovering, and their avoidance of further costly medical treatments. The study also provided valuable information regarding which treatment would lead to the most efficient use of our health care dollars. The research subjects were taken from four large, multicenter, randomized clinical trials to amass a substantial pool for assessing outcome differences.

The results found the cervical disc replacement added up to a total five-year estimated cost of $102,274 using consistent medical billing codes across each patient’s surgery and follow-up visits. The anterior cervical discectomy and fusion resulted in a more expensive a five-year estimated cost of $119,814. The study also aimed to quantify how much the surgery improved each patient’s perceived quality of life. The two surgeries resulted in similar (2.8 quality-adjusted life years) durations, with the disc replacement favoring the fusion by 0.03 years. The disc replacement was also found to be more cost-effective with an average decreased cost of $17,540 over the neck fusion procedure.

The authors conclude that the cost-effective estimation model they used showed a narrow advantage for the cervical disc replacement as it was less costly, effective at reducing the neck pain complaints, and had solid utility up to five years after the surgery. The cost-effectiveness estimation model they used, however, was unable to predict the long-term success of either surgery’s hardware, and the potential for either failing, thus requiring more surgery and changing their estimated effectiveness.

References: McAnany S. J., MD, et al. The 5-Year Cost-effectiveness of Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement: A Markov Analysis. In SPINE Nov. 2014. Vol. 39, Pp. 1924-1933.

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