General Session: MIS-3
Presented by: P.C. McAfee - View Audio/Video Presentation (Members Only)
P.C. McAfee(1), I.L. Fedder(1), M.D. Dabbah(1), B.W. Cunningham(2), A.A. Murgatroyd(2), L. Chotikul(1), E. Shucosky(1)
(1) University of Maryland St. Joseph Medical Center, Scoliosis and Spine Institute, Towson, MD, United States
(2) Globus Medical, Musculoskeletal Education and Research Center, Audubon, PA, United States
Purpose: The purpose of the current investigation was to compare the cost data and readmission rates between single level anterior cervical discectomy and fusion (ACDF) procedures using allograft and anterior cervical plates versus intracorporeal fixation using a PEEK interbody spacer with integrated screws.
Methods: A consecutive series of 233 patients presenting with single level cervical radiculopathy, myelopathy, or spondylosis underwent ACDF with a PEEK spacer integrated screw system. For all cases, the PEEK cages were packed with local autogenous graft. A cohort of 6,661 ACDF patients as reported by Radcliff et al (SPINE 2015) and Wohns (Surgery Neurol Int 2010) were used for comparison. Patients presented with single-level cervical pathology and claims reflecting at least 6 weeks of nonsurgical preoperative care without claims history of prior surgery. Surgical treatment in this cohort consisted of an ACDF procedure utilizing allograft and an anterior cervical plate. Statistical comparison of the readmission data sets was performed using a chi squared analysis.
Results: A total of 6,894 ACDF patients comprise the basis of this analysis. 233 patients received a PEEK interbody spacer with integrated screws and autogenous graft, while a historical cohort of 6,661 patients were treated using allograft augmented with an anterior cervical plate. The readmission/reoperation rates were not significantly different in the allograft with anterior plate group (7.75%) versus the PEEK spacer group (3.1%) (chi square=1.914, p=0.167). The average cost for PEEK spacer with integrated screws was $24,101, while the average cost of the allograft with anterior plate group was $41,737. Using a PEEK spacer with integrated screws was on average 42.3% less costly than using allograft augmented with an anterior cervical plate.
Conclusion: Patients who underwent ACDF employing a PEEK interbody spacer with integrated screws for single-level degenerative disease exhibited trends of lower readmission / reoperation rates and reduced total costs than those treated with allograft and anterior cervical plates. The current study serves as the first cost and readmission rates based analysis comparing single level ACDF procedures using allograft and plates versus PEEK interbody spacers with integrated screws.