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The Total Cost to the Health Care System in Medicare and Medicaid Patients for the Treatment of Cervical Myelopathy

Schroeder, Gregory D., MD; McKenzie, James C., MD; Casper, David S., MD; Kurd, Mark F., MD; Hilibrand, Alan S., MD; Woods, Barret I., MD; Radcliff, Kris E., MD; Rihn, Jeffery A., MD; Anderson, David Greg, MD; Vaccaro, Alexander R., MD, PhD; Kepler, Christopher, MD, MBA

doi: 10.1097/BSD.0000000000000757

Introduction: Cervical myelopathy is a common indication for spine surgery. Modern medicine demands high quality, cost-effective treatment. Most cost analyses fail to account for complication costs from nonoperative treatment. The purpose is to compare the total health care costs for operative versus nonoperative treatment of cervical myelopathy.

Methods: The Center for Medicare and Medicaid Services Carrier File from 2005 to 2012 was reviewed using the PearlDiver database, representing a 5% sampling of Medicare billings which diagnosed patients with cervical myelopathy by International Classification of Diseases 9 code. Patients were separated into operative and nonoperative cohorts, and the total health care expenditures per patient normalized to 2012 dollars were collected.

Results: A total of 3209 patients were included, and 1755 (55.87%) underwent surgery. A 6-year cost analysis performed on 309 patients over the age of 65 from 2006 undergoing surgery resulted in a nonsignificant increase in total health care expenditures ($166,192 vs. $153,556; P=0.45). Operative treatment had a net decrease in total health care costs following the first year of surgery.

Conclusions: There is no significant difference in the total health care expenditures for operative versus nonoperative treatment of cervical myelopathy after 3 years. It is critical to understand that nonoperative treatment of this progressive disease leads to a substantial increase in total health care expenditures with increased risk of falls, injury, and further morbidity.

Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

There was no funding of any kind from the following sources: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI).

Dr Schroeder has received funds to travel from AO Spine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. The remaining authors declare no conflict of interest.

Reprints: James C. McKenzie, MD, Department of Orthopaedic Surgery, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107 (e-mail:

Received July 10, 2017

Accepted July 3, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.