Department of Neurosurgery, Naval Medical Center San Diego, California 92134, USA.
Neurosurg Focus. 2010 May;28(5):E17. doi: 10.3171/2010.1.FOCUS09305.
To review the cost effectiveness for the management of a unilateral cervical radiculopathy with either posterior cervical foraminotomy (PCF) or anterior cervical discectomy and fusion (ACDF) in military personnel, with a particular focus on time required to return to active-duty service.
Following internal review board approval, the authors conducted a retrospective review of 38 cases in which patients underwent surgical management of unilateral cervical radiculopathy. Nineteen patients who underwent PCF were matched for age, treatment level, and surgeon to 19 patients who had undergone ACDF. Successful outcome was determined by return to full, unrestricted active-duty military service. The difference in time of return to active duty was compared between the groups. In addition, a cost analysis consisting of direct and indirect costs was used to compare the PCF group to the ACDF group.
A total of 21 levels were operated on in each group. There were 17 men and 2 women in the PCF group, whereas all 19 patients in the ACDF group were men. The average age at the time of surgery was 41.5 years (range 27-56 years) and 39.3 years (range 24-52 years) for the PCF and ACDF groups, respectively. There was no statistically significant difference in operating room time, estimated blood loss, or postoperative narcotic refills. Complications included 2 cases of transient recurrent laryngeal nerve palsy in the ACDF group. The average time to return to unrestricted full duty was 4.8 weeks (range 1-8 weeks) in the PCF group and 19.6 weeks (range 12-32 weeks) in the ACDF group, a difference of 14.8 weeks (p < 0.001). The direct costs of each surgery were $3570 for the PCF and $10,078 for the ACDF, a difference of $6508. Based on the 14.8-week difference in time to return to active duty, the indirect cost was calculated to range from $13,586 to $24,045 greater in the ACDF group. Total cost (indirect plus direct) ranged from $20,094 to $30,553 greater in the ACDF group.
In the management of unilateral posterior cervical radiculopathy for military active-duty personnel, PCF offers a benefit relative to ACDF in immediate short-term direct and long-term indirect costs. The indirect cost of a service member away from full, unrestricted active duty 14.8 weeks longer in the ACDF group was the main contributor to this difference.
回顾颈椎单侧神经根病采用后路颈椎椎间孔切开术（PCF）或前路颈椎间盘切除术和融合术（ACDF）治疗的成本效益，特别关注恢复现役服务所需的时间。
在内部审查委员会批准后，作者对 38 例接受单侧颈椎神经根病手术治疗的患者进行了回顾性研究。19 例接受 PCF 的患者与年龄、治疗水平和外科医生相匹配，与 19 例接受 ACDF 的患者相匹配。成功的结果通过恢复全面、不受限制的现役军事服务来确定。比较两组之间返回现役的时间差异。此外，使用直接和间接成本的成本分析来比较 PCF 组和 ACDF 组。
每组共手术 21 个节段。PCF 组 17 名男性和 2 名女性，而 ACDF 组 19 名患者均为男性。手术时的平均年龄分别为 41.5 岁（27-56 岁）和 39.3 岁（24-52 岁）。手术时间、估计失血量或术后阿片类药物补充无统计学差异。并发症包括 ACDF 组 2 例短暂性喉返神经麻痹。PCF 组平均恢复到无限制的全职工作时间为 4.8 周（1-8 周），ACDF 组为 19.6 周（12-32 周），差异为 14.8 周（p < 0.001）。PCF 的每次手术直接费用为 3570 美元，ACDF 的每次手术直接费用为 10078 美元，差异为 6508 美元。基于恢复现役的 14.8 周差异，计算出 ACDF 组的间接费用为 13586 美元至 24045 美元。ACDF 组的总费用（间接加直接）范围为 20094 美元至 30553 美元。
在管理现役军事人员的单侧颈椎后神经根病时，PCF 在直接短期和长期间接成本方面相对于 ACDF 具有优势。ACDF 组服务成员离开全面、不受限制的现役服务 14.8 周的间接成本是造成这种差异的主要原因。
