Historical trends and future projections of cervical disc arthroplasty and removal cervical disc arthroplasty in the United States Medicare population

Abstract

Background

Cervical disc arthroplasty (CDA) has become an increasingly utilized alternative to anterior cervical discectomy and fusion (ACDF), offering potential benefits such as motion preservation and reduced incidence of adjacent segment disease. However, long-term utilization trends and future procedural burden remain unclear.

Methods

Medicare fee-for-service (FFS) cervical disc arthroplasty (CDA) volumes were extracted from the Medicare Part B National Summary between 2009 and 2022, excluding 2020, and uplifted to account for Medicare Advantage enrollment. Statistical models developed included ordinary least squares (OLS), generalized linear models (GLM), and segmented regression to detect any inflection points in utilization. Autoregressive and alternative GLMs such as Poisson and negative binomial were used for validation. For each procedure type, the model that best aligned with observed trends and statistical fit (AIC, R²) was used to generate forecasts through 2035.

Results

Primary CDA utilization demonstrated an inflection point in 2018, after which growth stabilized. Post 2018 OLS modeling estimated a 6.2% annual growth rate, reaching an estimated 9,422 procedures by 2035 (95% CI: 5,494–16,159). Removal CDA exhibited consistent exponential growth, with GLM estimated 22.9% annual increase and a projected volume of 1,773 procedures by 2035 (95% CI: 1,183–2,656).

Conclusions

Primary CDA may be entering a mature adoption phase with modest projected growth, while removal CDA is expected to grow more substantially. These projections reflect trends in an older population, which may not generalize to younger individuals undergoing CDA. Our findings reinforce the need for continued surveillance, resource planning, and better understanding of long-term CDA complications in the increasingly aging population.