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Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: Current State and Trends in Treatment for Cervical Disc Pathology

Nesterenko, Sergiy O., MD; Riley, Lee H. III, MD; Skolasky, Richard L., ScD

doi: 10.1097/BRS.0b013e31824ee623
Cervical Spine

Study Design. Epidemiologic study using national administrative data.

Objective. To compare anterior cervical discectomy and fusion (ACDF) with cervical disc arthroplasty (CDA) for the treatment of cervical disc pathology in terms of (1) patient and hospital characteristics, length of stay, and total charges; and (2) temporal changes in those variables and in overall numbers.

Summary of Background Data. Studies have shown that CDA has results and safety profiles comparable with those of ACDF, but information on patient and hospital characteristics and economical impact of CDA is lacking.

Methods. We queried the Nationwide Inpatient Sample for all hospitalization records from 2005 through 2008 with International Classification of Diseases, Ninth Revision, Clinical Modification codes corresponding to ACDF or CDA, used multivariable linear regression analyses (significance, P, 0.05) for patient and hospital characteristics, and calculated length of stay parameters. For total hospital charges, we used the consumer price index to convert all charges to 2008 US dollars.

Results. Most of the 544,174 ACDF procedures occurred in the South; most of the 4,710 CDA procedures occurred in the West and South. Compared with patients undergoing ACDF, those undergoing CDA were younger (P, 0.001). Comorbid severity for ACDF increased over time (P, 0.001) but did not change for CDA (P = 0.664). Although hospital stay decreased for both groups, total hospital charges increased for ACDF but remained stable for CDA over time.

Conclusion. Patients undergoing CDA tended to be younger and to have less comorbidity, shorter hospital stays, and lower costs. The number of CDAs increased over time, although the percentage remained relatively small in comparison with that for ACDF.

Analysis of Nationwide Inpatient Sample shows that the number of cervical disc arthroplasty cases increased from 2005 to 2008 by more than 700%. Patients undergoing cervical disc arthroplasty tended to be younger and to have less comorbidity, shorter hospital stays, and lower costs than those undergoing anterior discectomy and fusion.

From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Richard L. Skolasky, ScD, c/o Elaine P. Henze, BJ, ELS, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A672, Baltimore, MD 21224; E-mail:

Acknowledgment date: December 21, 2011. First revision date: February 3, 2012. Acceptance date: February 6, 2012.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

Cervical Spine Research Society funds were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.