Both cervical TDR and ACDF groups showed excellent clinical outcomes that were maintained over long-term follow-up. Both groups showed low index-level and adjacent-level reoperation rates. Both cervical TDR and ACDF appear to be viable options for the treatment of single-level cervical radiculopathy.

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Study Design. Retrospective analysis of prospectively collected data. Objective. Assess the cost-utility of anterior cervical discectomy and fusion (ACDF) performed in the ambulatory surgery center (ASC) versus inpatient hospital setting for Medicare and privately insured patients at one-year follow-up. Summary of Background Data. Outpatient ACDF has gained popularity due to improved safety and reduced costs. Formal cost-utility studies for ambulatory versus inpatient ACDF are lacking, precluding an accurate assessment of cost-effectiveness. Materials and Methods. A total of 6504 patients enrolled in the Quality Outcomes Database (QOD) undergoing one-level to two-level ACDF at a single ASC (520) or the inpatient hospital setting (5984) were compared. Propensity matching generated 748 patients for analysis (374 per cohort). Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years (QALYs) were assessed. Direct costs (1-year resource use×unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays×average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated. Results. Complication rates and improvements in patient-reported outcome measures and QALYs were similar between groups. Ambulatory ACDF was associated with significantly lower total costs at 1 year for Medicare ($5879.46) and privately insured ($12,873.97) patients, respectively. The incremental cost-effectiveness ratios for inpatient ACDF was $3,674,662 and $8,046,231 for Medicare and privately insured patients, respectively, reflecting unacceptably poor cost-utility. Conclusion. Inpatient ACDF is associated with significant increases in total costs compared to the ASC setting without a safety, outcome, or QALY benefit. The ASC setting is a dominant option from a health economy perspective for first-time one-l to two-level ACDF in select patients compared to the inpatient hospital setting.

Background: Cervical pedicle screws provide significant biomechanical advantage but can be technically challenging and associated with morbid exposure. Improvements in intraoperative navigation guidance and instrumentation have made feasible this biomechanically robust, but technically challenging procedure. We present our initial experience with minimally invasive (MIS) percutaneous pedicle screw fixation in the cervical atlantoaxial and subaxial spine.Methods: A retrospective review was performed on 27 cases that involved a novel MIS percutaneous cervical pedicle screw technique. Small lateral skin incisions were made bilaterally on the neck using intraoperative navigation guidance. Subsequently, navigated, percutaneous screws were placed using the Proficient Minimally Invasive System (PROMIS; Spine Wave, Shelton, CT). Computed tomography (CT)-guided navigation was used for cervical pedicle screw placement with subsequent placement of percutaneous rods.Results: Indications for surgery included type II odontoid fractures, subaxial fracture dislocations and burst fracture, metastatic pathological burst fracture, and degenerative spondylosis with stenosis. There were 15 men and 12 women, with an average age 63.5 years. Follow-up ranged from 3 to 24 months (average ¼ 16.7 months). One screw was revised intraoperatively. Two patients (7.7%) required reoperation, 1 patient required repositioning of a C5 pedicle screw, and 1 suffered a C7 body fracture. No nerve root injury, spinal cord injury, or vertebral artery injuries were reported.Conclusions: Percutaneous cervical pedicle screw fixation is a feasible and safe technique when performed with CT-guided intraoperative navigation techniques. Cervical pedicle screw fixation provides a biomechanically superior construct in comparison with a lateral mass technique. In addition, the lack of paraspinal muscle disruption preserves important stabilizers of the posterior ligamentous complex and may reduce wound-healing issues in high-risk cases (eg, trauma patients). Although the current role for percutaneous instrumentation is relatively narrow, the advancement of MIS posterior cervical techniques may provide expanded opportunities in the future.