I'm trying to figure out a way to afford neck surgery. I don't have very good insurance (high deductible, minimal coverage). I can either have an anterior discectomy and fusion or a disc replacement. The surgeon's assistant went over all the possible choices but I still can't quite tell which one is the least expensive but still do the job. Can you help me out?
We can offer you the following information. This comes from a study performed by the Miller Scientific Consulting company in San Francisco, California. They investigated the results of treatment using the anterior cervical discectomy and fusion (ACDF) and disc replacement procedures you are considereing.
The fusion is accomplished with bone grafts or titanium cages. A decision must be made between bone grafts from the patient (autografts) or from a donor bank (allograft). There are price differences.
Each of these choices has positives and negatives associated with it. Weighing the benefits against the disadvantages doesn't always give a clear picture of how the results from each of these approaches compares. That's where this study comes in. This is the first study to compare the results of all four choices: 1) anterior cervical discectomy and fusion (ACDF) with allograft, 2) ACDF with autograft, 3) ACDF with cages, and 4) disc replacement called arthroplasty.
The authors of the article didn't actually treat patients with these four methods and then compare the results. Instead, they reviewed all of the published studies on these topics and analyzed the data to get a general idea of how they compared.
Results were measured based on patient outcomes of neck and arm pain, neck disability, physical and mental function, and fusion rate (based on X-rays). Neck disability was measured using a special patient survey called neck disability index (NDI). There was one other measure used to compare the groups and that was adverse events (complications or problems) during or after surgery.
There wasn't much difference in the final results among all of these surgical treatments. It seems that no matter how it's done, removing the disc and any bone spurs that are pressing on the spinal nerve(s) gives immediate pain relief. But just removing these tissues would leave the spinal segment unstable. That's why the affected spinal segment is supported with fusion or disc replacement.
So the question is still: which one of these approaches to fusion or disc replacement is best? With similar results in pain relief and function, other factors must be considered. For example, autografts require the harvesting of bone from the pelvic bone.
This procedure means a longer time in the operating room under anesthesia. Many studies have shown that the donor site can become a new source of pain or discomfort. There are no such side effects with allograft. The main concern with bone from a donor bank is rejection (rare). The major downside of fusion (no matter how it's done) is the loss of neck motion.
Disc removal and replacement with an implant restores neck motion but is a much more expensive procedure. The surgery is much more complicated and takes much longer. The high cost of the disc implant must be factored in too. And since cervical disc replacements have only been around for the last five years, we don't have long-term studies to see how well they hold up or if there are any problems down the road.
The authors concluded that with the improvements that have been made in preparation of allografts (from the bone bank) the advantages of allograft over autograft are clear. Eliminating the donor site pain that often interferes with daily activities is a big benefit of allograft fusion. The ACDF procedure with allograft costs half that of autografts. Allograft safety record is well-documented making this an excellent choice for anterior discectomy and fusion.
There's no doubt you will need to talk with the physician's business office to find out the potential charges for each procedure. Then take this information to your insurance company and see what they will cover. You may have to have prior authorization anyway -- and it's possible the insurance company covers one procedure but not another.