Trends in Cervical Spine Surgery in the United States: A National Database Analysis

Anterior cervical discectomy and fusion (ACDF), posterior cervical instrumented fusion (PCF), laminectomy/foraminotomy/facetectomy (LFF), and cervical disc arthroplasty (CDA) are commonly performed cervical spine procedures. This study aims to identify the trends in cervical spine surgery on the utilization of ACDF, PCF, LFF, and CDA in the United States over the past decade. A secondary aim of this study is to describe the average reimbursements received for these interventions.

This retrospective cohort study was conducted using the PearlDiver database in patients undergoing ACDF, LFF, PCF, and CDA from 2010-2022. Yearly number of procedures from 2010-2022 and average reimbursement per patient were reported for all four cohorts. PearlDiver's built-in statistical package and R Studio were used to report the results and create a choropleth map.

Out of 1.2 million cervical spine surgeries, ACDF was most common (61.6%), followed by LFF (22.1%), PCF (14.0%), and CDA (3.4%). ACDF, LFF, and PCF were common in patients aged 55-74, while CDA was more common in patients aged ≤54. The number of cervical spine surgeries grew from 86,272-96,976, while the number of ACDFs fell from 60,435-51,012. LFF, PCF, and CDA continued to increase in frequency until 2022. The average inflation-adjusted yearly percentage change in reimbursements was -9% per year.

ACDF has been the most popular cervical spine surgery, but its frequency is now declining. CDA is gaining popularity, particularly among younger patients. Moreover, average per-patient inflation-adjusted reimbursements have been effectively decreasing over time.