Cost-effectiveness of three-level cervical disc arthroplasty vs. anterior discectomy and fusion: a comparative...

Cervical degenerative disc disease is a common indication for surgical intervention to stabilize vertebral segments and alleviate symptomatic radiculopathy or myelopathy. While anterior cervical discectomy and fusion (ACDF) has long been a standard procedure for these cases, more recently, cervical disc arthroplasty (CDA) has offered a motion preserving alterative to potentially reduce adjacent segment degeneration (ASD). Although cost-effectiveness data exist for single- and two-level procedures, there remain no direct comparisons for three-level CDA constructs. This study retrospectively evaluates admission costs and 3-month clinical outcomes between three-level CDA and ACDF to evaluate each procedure's relative cost-effectiveness.

In this single-system retrospective study, patients receiving elective three-level CDA (n=10) or ACDF (n=10) for degenerative cervical pathology were compared. Exclusion criteria included acute trauma, infection, or tumors. Data collected included patient demographics, comorbidities, symptoms, radiological findings, procedural details, postoperative complications, and 3-month clinical outcomes. Financial metrics, normalized to institutional cost units, included total admission costs and subcategories [e.g., equipment cost, operating room (OR) cost]. Statistical comparisons employed Kruskal-Wallis and chi-square tests (P<0.05 threshold).

Cohorts exhibited comparable baseline characteristics, including age (CDA: 52.3±9.6 years; ACDF: 58.7±7.4 years), comorbidities, symptoms, and diagnoses (P>0.05). Operative times trended longer for CDA (268.6±40.7 min) vs. ACDF (222.8±84.4 min; P=0.08). No intraoperative complications occurred in either cohort, and postoperative complications were not significantly higher for CDA vs. ACDF (30% vs. 10%; P=0.58). There were no significant differences in 3-month symptom resolution and readmission/reoperation rates between procedures (P>0.40). Total admission costs were markedly elevated for CDA (78.04 units) compared to ACDF (46.25 units; +68.75%, P<0.001), driven predominantly by equipment costs (+152.34%, P<0.001), with lesser increases in OR (+32.97%, P=0.006), anesthesia (+56.0%, P=0.008), and radiology costs (+74.56%, P=0.005).

Three-level CDA incurs substantially higher admission costs than ACDF without short-term clinical superiority. These findings highlight equipment-driven cost differences amid comparable clinical efficacy, suggesting ACDF may be superior to CDA in three-level cases where motion preservation is not essential and cost is a significant consideration. However, further cost-utility analyses are necessary to evaluate how differences in long-term ASD rates and reoperations may compensate for the higher short-term admission costs of CDA.