Abstract
INTRODUCTION
Cervical radiculopathy remains highly prevalent and costly in the U.S. healthcare system. While ACDF has remained the most popular surgical treatment modality, minimally invasive advancements such as posterior micro-endoscopic discectomy/foraminotomy (pMED) has emerged as a motion preserving and less invasive alternative. To date, the comparative effectiveness and cost-effectiveness of pMED vs. ACDF remains unclear.
METHODS
Patients undergoing surgery for single-level radiculopathy without myelopathy resulting from foraminal stenosis or foraminal disc herniation without instability over a one-year period were prospectively enrolled into an institutional database. Baseline, post -operative 3-months, and 12-months VAS-Arm and Neck, NDI, EQ −5D, and return to work(RTW) status were collected. Direct healthcare cost(payer perspective) and indirect cost (work-day losses multiplied by median gross-of-tax wage and benefits rate) was assessed.
RESULTS
>Total 20 ACDF and 28 pMED patients were identified. Baseline demographics, symptomatology, and co-morbidities were similar between the cohorts. For pMED vs. ACDF, mean length of surgery (48.1 ± 20.0 vs. 69.9 ± 11.6 minutes, P < 0.0001) and estimated blood loss (20.3 ± 9.3 vs. 31.8 ± 15.4 mL, P = 0.04) was reduced. There was no 90-day morbidity or re-admission for either cohort. One(3.6%) pMED patient required a subsequent ACDF; no patients in the ACDF cohort required re-operation by one-year. pMED and ACDF cohorts demonstrated similar improvement in arm-VAS(3.1 vs. 2.6, P = 0.66), neck-VAS(2.0 vs. 3.2, P = 0.24), NDI(9.0 vs. 6.8, P = 0.24), and EQ-5D(0.17 vs. 0.15, P = 0.82). Ability to RTW(93.8% vs. 94.1%, P = 1.0) and median time to RTW(3.7[0.9- 8.1] vs. 3.6[2.1-8.5] weeks, P = 0.85) were similar. pMED was associated with significantly reduced direct cost (p>0.001) but similar indirect cost (P = 0.43), resulting in an average total cost savings of $7689(P < 0.01) per case with similar QALY-gain (0.17 vs. 0.15, P = 0.82).
CONCLUSION
For single-level unilateral-radiculopathy resulting from foraminal stenosis or lateral disc herniation without segmental instability, pMED was equivalent to ACDF in safety and effectiveness. pMED represents a minimally invasive, motion preserving alternative to select patients with cervical radiculopathy without the need for implant costs with concomitant significant cost saving.
Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation
