Single-Institution Retrospective Propensity Score-Matched Comparative Cost Analysis of Multilevel Anterior Cervical Discectomy and Fusion versus Posterior Cervical Decompression and Fusion in Geriatric Patients with Cervical Disc Herniation

Abstract

Background

Despite the surge in anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) procedures over the past 2 decades, there remains a paucity of data on their comparative costs in geriatric patients with cervical disc herniation. This study provides a comprehensive cost analysis of ACDF and PCDF in this patient population.

Methods

A total of 282 geriatric patients who underwent ACDF or PCDF for cervical disc herniation over a 12-year period were analyzed to assess total surgical costs, including preoperative, procedural, and postoperative expenses. Analysis of variance with post-hoc Tukey Honestly Significant Difference test was used in a propensity score-matched cohort to compare cost differences between ACDF and PCDF across various cost categories.

Results

In a geriatric cohort of 282 patients with cervical disc herniation meeting inclusion criteria, 221 (78.4%) underwent ACDF and 61 (21.6%) received PCDF (2–4 levels). The average age was 71.3 ± 5.6 years, with no significant demographic differences between groups. On analysis of variance, rehabilitation costs were 1.88 times higher (P < 0.001), and blood bank costs were 2.16 times higher (P = 0.04) for PCDF patients, corresponding with significantly greater estimated blood loss (209.9 ± 217.7 mL vs. 66.7 ± 107.0 mL; P < 0.001). After propensity score matching, PCDF remained associated with significantly higher rehabilitation costs (+170.79%; P < 0.001), blood bank costs (+139.29%; P = 0.005), and total procedural costs (+33.92%; P = 0.015).

Conclusions

ACDF procedures in geriatric patients with cervical disc herniation are significantly cheaper than PCDF in terms of rehabilitation and blood bank costs, offering valuable insights for optimizing neurosurgical decision-making and high-value care.