Comparison of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion Among Medicare Beneficiaries: A Nationwide Analysis Using the Medicare Claims Database

Introduction: To date, no nationwide plan regarding coverage of cervical disc arthroplasty (CDA) in Medicare beneficiaries has been established. While CDA has been characterized as not medically necessary in sexagenarians, the perioperative outcomes and costs of CDA and anterior cervical discectomy and fusion (ACDF) in patients receiving Medicare coverage remain to be determined.

Methods: The Medicare Claims Database was queried to identify cases of CDA and ACDF treated in 2018. Patients who underwent CDA or ACDF were propensity matched based on demographics and baseline characteristics, such as patient sex and race. Clinical outcomes, as well as cost- and payment-related parameters were compared among patients who underwent CDA versus ACDF.

Results: A total of 117 patients who underwent CDA, and 6,693 patients who underwent ACDF were identified, and 234 patients (117 per group) were included in the propensity matched cohort analysis. Patients undergoing CDA were significantly less likely to be discharged to a skilled nursing or rehabilitation facility (2.6% vs. 13.7%, p=0.01) compared to patients undergoing ACDF. In addition, patients in the CDA group had significantly less covered days of care (2.4 ± 4.6 vs. 3.9 ± 5.6 days, p=0.03) compared to patients in the ACDF group. While the total charges amount for all claim-related services did not significantly differ between the CDA and ACDF groups ($109,289.4 ± 95,983.2 vs. $116,732.1 ± 118,187.1, p=0.6), patients who underwent CDA had a significantly higher mean non-covered payment amount compared to patients who underwent ACDF ($13,176 ± 37,747.3 vs. $4,702 ± 20,443, p=0.03).

Conclusion : Among patients undergoing CDA or ACDF identified in the Medicare Claims Database, patients undergoing CDA were more likely to have a favorable discharge disposition, and had fewer days, and a smaller proportion of their care covered by Medicare compared to patients undergoing ACDF. Our analysis highlights the lack of a nationwide plan for CDA coverage in patients entitled to Medicare benefits.