Background: Despite the surge in anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) procedures over the past 2 decades, there remains a paucity of data on their comparative costs in geriatric patients with cervical disc herniation. This study provides a comprehensive cost analysis of ACDF and PCDF in this patient population.

Methods: A total of 282 geriatric patients who underwent ACDF or PCDF for cervical disc herniation over a 12-year period were analyzed to assess total surgical costs, including preoperative, procedural, and postoperative expenses. Analysis of variance with post-hoc Tukey Honestly Significant Difference test was used in a propensity score-matched cohort to compare cost differences between ACDF and PCDF across various cost categories.

Results: In a geriatric cohort of 282 patients with cervical disc herniation meeting inclusion criteria, 221 (78.4%) underwent ACDF and 61 (21.6%) received PCDF (2-4 levels). The average age was 71.3 ± 5.6 years, with no significant demographic differences between groups. On analysis of variance, rehabilitation costs were 1.88 times higher (P < 0.001), and blood bank costs were 2.16 times higher (P = 0.04) for PCDF patients, corresponding with significantly greater estimated blood loss (209.9 ± 217.7 mL vs. 66.7 ± 107.0 mL; P < 0.001). After propensity score matching, PCDF remained associated with significantly higher rehabilitation costs (+170.79%; P < 0.001), blood bank costs (+139.29%; P = 0.005), and total procedural costs (+33.92%; P = 0.015).

Conclusions: ACDF procedures in geriatric patients with cervical disc herniation are significantly cheaper than PCDF in terms of rehabilitation and blood bank costs, offering valuable insights for optimizing neurosurgical decision-making and high-value care.