Inpatient Level of Care is NOT Medically Necessary for Cervical Disc Arthroplasty at C4-C5
Cervical disc arthroplasty for single-level degenerative disc disease with moderate canal stenosis should be performed as an outpatient procedure, as this patient meets all clinical criteria for the surgery itself but does not require inpatient admission based on current evidence and guidelines. 1, 2
Medical Necessity of the Procedure Itself
The patient does meet criteria for cervical disc arthroplasty at C4-C5 based on the following:
Neural compression is documented: The patient has cervical radiculopathy with moderate canal stenosis from a central disc protrusion with annular tear at C4-C5, which meets the threshold of "moderate, moderate to severe, or severe stenosis" required by guidelines 1, 2
Conservative management has been completed: The patient has failed at least 6 weeks of conservative therapy, which is an absolute requirement before surgical intervention 1, 2
No segmental instability: MRI shows no radiologic evidence of segmental instability, which is a critical requirement for arthroplasty candidacy 1, 2
Functional impairment is present: The patient's activities of daily living are limited by symptoms of neural compression, meeting another key criterion 1
Clinical-radiographic correlation exists: Signs and symptoms of neural compression (radiculopathy) correspond with the C4-C5 level shown on imaging 1, 2
Why Outpatient Status is Appropriate
The procedure itself is classified as an ambulatory/outpatient surgery according to multiple sources:
The MCG guidelines specifically classify cervical disc arthroplasty as an ambulatory procedure with zero inpatient days 1
Single-level cervical disc arthroplasty has demonstrated excellent safety profiles with 90.1% symptom relief and 93.0% return to full activity in outpatient settings 3
Cervical arthroplasty demonstrates equivalent or better outcomes compared to fusion, with reoperation rates of only 3.5% in single-level procedures performed as outpatient surgery 3
Patient-Specific Factors Do Not Require Inpatient Care
No high-risk features are present that would necessitate inpatient admission:
The patient is skeletally mature and appropriate for the procedure 1, 2
Single-level disease at C4-C5 carries lower surgical complexity compared to multilevel procedures 1
Moderate stenosis (rather than severe myelopathy) indicates lower neurological risk 4
The decreased size of the disc protrusion on current imaging suggests stable rather than acute progressive pathology 1
Common Pitfalls to Avoid
Do not confuse medical necessity of the procedure with medical necessity of inpatient admission—these are separate determinations. The surgery is medically necessary, but inpatient care is not 1, 2
Ensure flexion-extension radiographs have been obtained to definitively rule out segmental instability before proceeding with arthroplasty, as static MRI alone is insufficient 1
Verify the patient has no contraindications including inflammatory spondyloarthropathy, osteoporosis, previous cervical surgery at C4-C5, or active infection 2
Document that an FDA-approved prosthetic device will be used, as this is a specific requirement for medical necessity 2
Clinical Outcomes Supporting Outpatient Approach
Cervical arthroplasty achieves 80-90% success rates for arm pain relief in appropriately selected patients 1
At 3-year follow-up, clinical and radiographic outcomes remain excellent with motion preservation in 92.5-95.8% of patients 4
The procedure provides more rapid relief (within 3-4 months) compared to continued conservative management 1
Heterotopic ossification occurs in approximately 47% of patients but does not significantly impact clinical outcomes 4