Radio diagnosis

The researches find that the To examine the costs associated with nonoperative management (diagnosis and treatment) of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion (ACDF). While the costs of operative treatment have been previously describe; because less is know about nonoperative management costs of cervical radiculopathy leading up to surgery. But The Humana claims dataset  was queried to identify adult patients with cervical radiculopathy that underwent ACDF.

The cervical radiculopathy

Outcome endpoint was assessment of cumulative and per-capita costs for nonoperative diagnostic (x-rays, computed tomographic [CT], magnetic resonance imaging [MRI]; electromyogram/nerve conduction studies [EMG/NCS]) and treatment modalities (injections, physical therapy [PT]; braces, medications, chiropractic services) in the year preceding surgical intervention. Overall 12,514 patients (52% female) with cervical radiculopathy underwent ACDF. Cumulative costs and per-capita costs for nonoperative management, during the year prior to ACDF was $14.3 million and $1143, respectively.

All patients underwent at least one diagnostic test (MRI: 86.7%; x-ray: 57.5%; CT: 35.2%) while 73.3% patients received a nonoperative treatment. Therefore Diagnostic testing comprised of over 62% of total nonoperative costs ($8.9 million) with MRI constituting the highest total relative spend ($5.3 million; per-capita: $489) followed by CT ($2.6 million; $606), x-rays ($0.54 million; per-capita: $76), and EMG/NCS ($0.39 million; per-capita: $467).

Patients failing nonoperative

Conservative treatments comprised of 37.7% of the total nonoperative costs ($5.4 million) with injections costs constituting the highest relative spend ($3.01 million; per-capita: $988) followed by PT ($1.13 million; per-capita: $510) and medications (narcotics: $0.51 million, per-capita $101; gabapentin: $0.21 million, per-capita $93; NSAIDs: 0.107 million, per-capita $47), bracing ($0.25 million; per-capita: $193); and chiropractic services ($0.137 million; per-capita: $193). Cervical radiculopathy is a condition cause by compression of cervical nerve roots resulting in burning upper extremity pain, weakness, alter sensation, and impairment of deep tendon reflexes.

The majority of patients experiencing cervical radiculopathy have symptom resolution within 3 months with nonoperative management. For patients failing nonoperative management; the gold standard treatment is anterior cervical discectomy and fusion (ACDF) which is associated with a high clinical success. The number of ACDF procedures has been shown to be increasing yearly, with one studying revealing a 184% increase in Medicare beneficiaries from 12.6 in 1992 to 35.8 per 100,000 in 2005.

The cumulative nonoperative

While the costs of ACDF have been previously described,  less is know about the nonoperative costs associate with cervical spine disorders including radiculopathy leading up to ACDF. Long-term costs societal costs in a middle-aged patient undergoing ACDF is estimated to be $31,178; however, little or no literature exist that comprehensively describes the costs preceding cervical spine surgery. Therefore A recent study noted the cumulative nonoperative intervention charges including halo-placement and spinal traction in patients with axis (C2) fracture to be approximately $24.3 million in 2011, translating to a mean per-capita overhead charge of $62,396 (inflation-adjusted to 2013-dollar values).