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Updated: Apr 23, 2026
Anterior Cervical Discectomy and Fusion in the Ovine Model
Published on: October 5, 2009
Anterior surgical management of single-level cervical disc disease: a cost-effectiveness analysis
Daniel J Lewis1, Mark A Attiah, Neil R Malhotra
1*Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA †Baylor College of Medicine, Houston, TX ‡Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; and §NeuroTexas Institute, Austin, TX.
Study Design:
Cost-effectiveness analysis with decision analysis and meta-analysis.
Objective:
To determine the relative cost-effectiveness of anterior cervical discectomy with fusion (with autograft, allograft, or spacers), anterior cervical discectomy without fusion (ACD), and cervical disc replacement (CDR) for the treatment of 1-level cervical disc disease.
Summary Of Background Data:
There is debate as to the optimal anterior surgical strategy to treat single-level cervical disc disease. Surgical strategies include 3 techniques of anterior cervical discectomy with fusion (autograft, allograft, or spacer-assisted fusion), ACD, and CDR. Several controlled trials have compared these treatments but have yielded mixed results. Decision analysis provides a structure for making a quantitative comparison of the costs and outcomes of each treatment.
Methods:
A literature search was performed and yielded 156 case series that fulfilled our search criteria describing nearly 17,000 cases. Data were abstracted from these publications and pooled meta-analytically to estimate the incidence of various outcomes, including index-level and adjacent-level reoperation. A decision analytic model calculated the expected costs in US dollars and outcomes in quality-adjusted life years for a typical adult patient with 1-level cervical radiculopathy subjected to each of the 5 approaches.
Results:
At 5 years postoperatively, patients who had undergone ACD alone had significantly (P < 0.001) more quality-adjusted life years (4.885 ± 0.041) than those receiving other treatments. Patients with ACD also exhibited highly significant (P < 0.001) differences in costs, incurring the lowest societal costs ($16,558 ± $539). Follow-up data were inadequate for comparison beyond 5 years.
Conclusion:
The results of our decision analytic model indicate advantages for ACD, both in effectiveness and costs, over other strategies. Thus, ACD is a cost-effective alternative to anterior cervical discectomy with fusion and CDR in patients with single-level cervical disc disease. Definitive conclusions about degenerative changes after ACD and adjacent-level disease after CDR await longer follow-up.
Level Of Evidence:
4.
