Trends in Anterior Cervical Discectomy and Fusion: Medicare Projections Through 2060

Study Design: Retrospective analysis using national Medicare data. Objectives: To evaluate historical trends in single and multi-level ACDF utilization and project future procedure volumes among Medicare beneficiaries through 2060. Methods: Publicly available data from the Centers for Medicare and Medicaid Services (CMS) Medicare Part-B National Summary were analyzed for single-level and multi-level ACDF from 2011 through 2022. Analyses were limited to Part-B claims and therefore excluded inpatient-only procedure codes that are not reported in Part-B. Volumes were adjusted for Medicare Advantage enrollment. Four forecasting models were applied, with Poisson regression selected based on model performance. Point forecasts and 95% confidence intervals were generated through 2060. Results: Single-level ACDF volumes decreased by 0.32% from 2011 to 2022, with the largest annual increase from 2011 to 2012 (11.3%) and 5-year growth from 2011 to 2016 (25.7%). In contrast, multi-level ACDF volumes increased by 86.9%, with a 19.5% increase between 2011 and 2012 and 69.8% growth from 2011 to 2016. The Poisson model projected stable annual growth for single-level ACDF at 0.04%, reaching 8,789 procedures (95% CI: 8,606-8,973) by 2060. Multi-level ACDF is projected to grow by approximately 4.9% annually, reaching 377,826 procedures (95% CI: 376,622-379,031) by 2060. Conclusions: Single-level ACDF utilization is projected to remain stable, while multi-level ACDF is expected to increase substantially through 2060. These trends highlight the growing reliance on ACDF for complex cervical pathology and carry implications for surgical workforce planning, hospital resource allocation, and policy in an aging population.