OBJECTIVES: Published literature indicates that cervical total disc replacement (cTDR) may be associated with reduced reoperation rates versus anterior cervical discectomy and fusion (ACDF). This study evaluated commercial payment rates associated with reoperations of 1-level and 2+-level cTDR and ACDF surgeries to assist in quantifying the economic benefit of cTDR.

METHODS: Using IBM MarketScan^® Treatment Pathways Commercial Database, patients undergoing cTDR or ACDF between 2012 and October 31, 2018 were followed for six months to measure surgical reoperation occurrence and payment rates. A subset of patients experiencing surgical site infection were removed from the cohort to focus the analysis on mechanical-related failure modes.

RESULTS: This study included 11,740 patients undergoing cervical spine surgery (1-level: 5,365; 2+-level: 6,375) with a mean age of 52.4 years. The majority of patients were female (52%). Excluding surgical site infections, reoperation surgeries within six months of the index procedure were reported in 6% (n=346) of 1-level procedures and 5% (n=303) of 2+-level procedures. The median (IQR) commercial payments associated with 1-level reoperations were $29,833 (Q1: $23,139; Q3: $40,549) and 2-level reoperations were $35,086 (Q1: $23,849; Q3: $44,341).

CONCLUSIONS: Reoperations following cTDR and ACDF impact patient outcomes and add cost to the healthcare system. Innovative devices which reduce the incidence of cervical spine reoperations will offer demonstrable economic value to patients, healthcare providers, and payers.