ANTERIOR CERVICAL DISCECTOMY AND FUSION OR DISC ARTHROPLASTY FOR A SINGLE LEVEL CERVICAL DISC DISEASE: A COMPARATIVE STUDY OF OUTCOME AND COST-EFFECTIVENESS OF FOUR DIFFERENT TECHNIQUES

Abstract

Introduction: Although there are several accepted methods of surgical treatment for single level cervical radiculopathy, the choice depends on the surgeon’s preference. The techniques may vary in perioperative morbidity, short and long term outcome, but no study so far has analysed their cost-effectiveness. To compare the outcome and cost-effectiveness of four techniques commonly used for degenerative cervical disc pathology.

Methods: We conducted a observational cohort study from two spinal units. Between 1999 and 2004, 60 patients underwent surgery for single level anterior cervical disc pathology. Out of this 30 patients underwent their surgery in centre A the other 30 in centre B. Centre A used two ACDF techniques-group 1- plate and tricortical graft, group 2- plate, cage and bone substitute (BCP granules). Centre B used two other techniques- group 3- cage alone with autologous locally harvested graft, group 4- disc arthroplasty. We had 15 patients in each of the above four groups. Operating time, blood loss, duration of stay, donor site morbidity, analgesia requirements, and total cost incurred per patient were recorded. All patients were followed up at 6 weeks, 3 months, 6 months, 1 year and 2 years. The clinical outcome and pain assessment were done using the SF12 and VAS.

Results: The three Fusion groups had a similar radiological outcome. With appropriate statistical analysis, there were no differences in physical and mental domains of the SF12 or pain scores between the groups. The average operative time in the group 1 was 160 minutes, group 2 was 100 minutes, group 3 was 90 minutes and group 4 was 105 minutes. Average blood loss was minimal in all groups. The average hospital stay was of 5, 2.7, 2.5, 2 days for groups 1–4 respectively. The average total cost per patient in the group 1 (surgery+stay+plate) was £2790, group 2 (surgery+stay+plate+cage+BCP) was £2400, group 3 (surgery+stay+cage) was £1900, and group 4(surgery+stay+disc implant) was £2350.

Conclusion: All the techniques gave similarly satisfactory clinical outcomes but using cages alone could be more cost-effective than using iliac crest auto-graft for fusion. The disc arthroplasty was comparable to cage with bone substitute and plate in terms of outcome and may giev the surgeon an alternative choice in patients who are not keen on/ unfit for fusion.