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

Authors

Zachary T Hoglund, Varun G Kathawate, Christopher S Sollenberger, Albert Q Wu, Raphael Englander, Neha Rani, Jacob Saadoun, Elie Massaad, James M Schuster, Paul J Marcotte, Berje H Shammassian, William C Welch, David S Casper, Ali K Ozturk, Zarina S Ali, Neil R Malhotra, John H Shin, Brendan F Judy

Published in

Journal of spine surgery (Hong Kong). Volume 12. Issue 6. Pages 90. Jun 30, 2026. Epub May 21, 2026.

Abstract

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.

PMID:
42434584
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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