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What Are the Costs of Cervical Radiculopathy Prior to Surgical Treatment?

Barton, Cameron MD; Kalakoti, Piyush MD; Bedard, Nicholas A. MD; Hendrickson, Nathan R. MD; Saifi, Comron MD; Pugely, Andrew J. MD

doi: 10.1097/BRS.0000000000002983

Study Design. Retrospective, observational study.

Objective. To examine the costs associated with nonoperative management (diagnosis and treatment) of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion (ACDF).

Summary of Background Data. While the costs of operative treatment have been previously described, less is known about nonoperative management costs of cervical radiculopathy leading up to surgery.

Methods. The Humana claims dataset (2007–2015) was queried to identify adult patients with cervical radiculopathy that underwent ACDF. Outcome endpoint was assessment of cumulative and per-capita costs for nonoperative diagnostic (x-rays, computed tomographic [CT], magnetic resonance imaging [MRI], electromyogram/nerve conduction studies [EMG/NCS]) and treatment modalities (injections, physical therapy [PT], braces, medications, chiropractic services) in the year preceding surgical intervention.

Results. Overall 12,514 patients (52% female) with cervical radiculopathy underwent ACDF. Cumulative costs and per-capita costs for nonoperative management, during the year prior to ACDF was $14.3 million and $1143, respectively. All patients underwent at least one diagnostic test (MRI: 86.7%; x-ray: 57.5%; CT: 35.2%) while 73.3% patients received a nonoperative treatment. Diagnostic testing comprised of over 62% of total nonoperative costs ($8.9 million) with MRI constituting the highest total relative spend ($5.3 million; per-capita: $489) followed by CT ($2.6 million; per-capita: $606), x-rays ($0.54 million; per-capita: $76), and EMG/NCS ($0.39 million; per-capita: $467). Conservative treatments comprised of 37.7% of the total nonoperative costs ($5.4 million) with injections costs constituting the highest relative spend ($3.01 million; per-capita: $988) followed by PT ($1.13 million; per-capita: $510) and medications (narcotics: $0.51 million, per-capita $101; gabapentin: $0.21 million, per-capita $93; NSAIDs: 0.107 million, per-capita $47), bracing ($0.25 million; per-capita: $193), and chiropractic services ($0.137 million; per-capita: $193).

Conclusion. The study quantifies the cumulative and per-capital costs incurred 1-year prior to ACDF in patients with cervical radiculopathy for nonoperative diagnostic and treatment modalities. Approximately two-thirds of the costs associated with cervical radiculopathy are from diagnostic modalities. As institutions begin entering into bundled payments for cervical spine disease, understanding condition specific costs is a critical first step.

Level of Evidence: 3

The study examines nonoperative diagnostic and treatment costs for cervical radiculopathy prior to anterior cervical discectomy and fusion (ACDF) using a longitudinal claims database. On average, per capita spending prior to ACDF ($1,143) is meager compared with the costs of hospital stay for ACDF ($18,142) and professional payments ($4457).

Spine Surgery, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa

Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania.

Address correspondence and reprint requests to Andrew J. Pugely, MD, Spine Surgery, Department of Orthopedics Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242; E-mail:

Received 16 July, 2018

Revised 9 December, 2018

Accepted 28 December, 2018

A portion of the work was presented at the 45th Annual meeting of the Cervical Spine Research Society (CSRS) at Hollywood, Florida and at the 33rd Annual meeting of the North American Spine Society (NASS) at Los Angeles, CA as podium presentations.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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