Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Economic and Outcomes Analysis of Recalcitrant Cervical Radiculopathy

Is Nonsurgical Management or Surgery More Cost-Effective?

Rihn, Jeffrey A. MD; Bhat, Suneel MD; Grauer, Jonathan MD; Harrop, James MD; Ghogawala, Zoher MD; Vaccaro, Alexander R. MD, PhD; Hilibrand, Alan S. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: July 15, 2019 - Volume 27 - Issue 14 - p 533–540
doi: 10.5435/JAAOS-D-17-00379
Research Article

Introduction: This study directly compares the economical and clinical effectiveness of the use of cervical epidural injections and continued physical therapy versus surgical management in cases of cervical radiculopathy that have failed 6 weeks of conservative management.

Methods: A theoretical cohort of patients with cervical radiculopathy resistant to 6 weeks of noninvasive conservative management were simulated to treatment with either anterior cervical diskectomy and fusion (ACDF) or cervical epidural injections and continued physical therapy and analyzed with Markov chain decision tree Monte Carlo simulation.

Results: The average incremental cost-effectiveness ratio associated with ACDF was $6,768 per quality-adjusted life year over the lifetime of the patient, whereas the incremental cost-effectiveness ratio associated with cervical injections ranged from $9,033 to $4,044 per quality-adjusted life year based on the success rate.

Discussion: Our study suggests that for the management of recalcitrant cervical radiculopathy, ACDF remains the dominant strategy compared with cervical epidural injections if the surgical avoidance rate of such injections is less than 50%. If there is a greater than 50% surgery avoidance rate with injections, then cervical epidural injections would be considered a cost-effective strategy with a role in the management of cervical radiculopathy before surgery.

From the Department of Orthopeadic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA (Dr. Rihn, Vaccaro, and Dr. Hilibrand). the Department of Orthopaedic Surgery, Sentara Orthopaedic Trauma Specialists, Norfolk, VA (Dr. Bhat), the Department of Orhtopaedic Surgery, Yale University School of Medicine, New Haven, CT (Dr. Grauer), the Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA (Dr. Harrop), and the Department of Neurosurgery, Tufts University School of Medicine, Boston, MA (Dr. Ghogawala).

Correspondence to Dr. Hilibrand: ahilibrand@gmail.com

Supported by Cervical Spine Research Society and Special Projects Funding.

Dr. Rihn or an immediate family member serves as a paid consultant to Globus Medical; has stock or stock options held in XTANT Medical; and serves as a board member, owner, officer, or committee member of Cervical Spine Research Society, and North American Spine Society. Dr. Bhat or an immediate family member serves as a paid consultant to TIDI Products. Dr. Grauer or an immediate family member serves as a paid consultant to TIDI Products and serves as a board member, owner, officer, or committee member of American Academy of Orthopaedic Surgeons, American Journal of Orthopedics, and Lumbar Spine Research Society. Dr. Harrop or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of DePuy; serves as a paid consultant to DePuy; serves as an unpaid consultant to Asterias, Bioventus, and Tejin; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Asterias, Bioventus, and Tejjin; and serves as a board member, owner, officer, or committee member of Spine Universe, CNS Quarterly, Congress of Neurosurgeons Executive Board, Cervical Spine Research Society, Pennyslvania Neurological Society, Jefferson University Physicians, Lumbar Spine Research Society, and Council of Surgical Spine Societies. Dr. Ghogawala or an immediate family member serves as a board member, owner, officer, or committee member of Cervical Spine Research Society and North American Spine Society. Dr. Vaccaro or an immediate family member has received royalties from Aesculap, Atlas Spine, Globus Medical, Medtronic, SpineWave, and Stryker; serves as a paid consultant to Atlas Spine, DePuy, Gerson Lehrman Group, Globus Medical, Guidepoint Global, Innovative Surgical Design, Medtronic, Nuvasive, Orthobullets, SpineWave, Stout Medical, and Stryker; and has stock or stock options held in Advanced Spinal Intellectual Properties, Avaz Surgical, Bonovo Orthopaedics, Computational Biodynamics, Cytonics, Dimension Orthotics, Electrocore, Flagship Surgical, FlowPharma, Franklin Bioscience, Gamma Spine, Globus Medical, Innovative Surgical Design, Insight Therapeutics, Nuvasive, Paradigm Spine, Parvizi Surgical Innovations, Prime Surgeons, Progressive Spinal Technologies, Replication Medica, Spine Medica, Spinology, Stout Medical, and Vertiflex. Dr. Hilibrand or an immediate family member has received royalties from Amedica and Zimmer Biomet; has stock or stock options held in Lifespine and Paradigm spine; and serves as a board member, owner, officer, or committee member of American Academy of Orthopaedic Surgeons.

© 2019 by American Academy of Orthopaedic Surgeons
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website