Single-Institution Retrospective Propensity Score-Matched Comparative Cost Analysis of Multilevel ACDF versus PCDF in Geriatric Patients with Cervical Disc Herniation.

Abstract

Introduction: Despite the surge in Anterior Cervical Discectomy and Fusion (ACDF) and Posterior Cervical Decompression and Fusion (PCDF) procedures over the past two 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 pre-operative, procedural, and post-operative expenses. ANOVA with post-hoc Tukey HSD 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 ANOVA, 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).

Conclusion: 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.