T he authors report a single-center cost-utility analysis comparing anterior cervical discectomy and fusion (ACDF) and minimally invasive posterior cervical foraminotomy (MIPCF) in an outpatient surgery setting with 1-year follow-up. The sample size of 323 patients yielded 110 propensity-matched pairs (220 patients) which were analyzed for direct costs, indirect costs, and incremental cost-effectiveness ratios. 1 The results show similar complication rate, 90-day readmission, and reoperation profiles between the 2 procedures. Significantly higher total costs are reported for patients who underwent ACDF. The ACDF cohort showed greater improvement in health-state utility (QALYs) but was also associated with an overall higher preoperative Neck Disability Index (NDI) score. The ICER analysis demonstrated that ACDF was over $180 000 for Medicare patients and therefore exceeded standard societal willingness-to-pay thresholds. The authors conclude that ACDF may not be costeffective compared with MIPCF in the treatment of unilateral cervical radiculopathy. 1 This study does have several limitations acknowledged by the authors. Propensity matching was necessary because baseline differences existed between the 2 cohorts. These differences included a higher percentage of male patients and Hispanic/Latino patients in the MIPCF cohort and a higher percentage of smokers in the ACDF cohort. There are several assumptions which are required for this type of cost-utility analysis, and important cost drivers were not included, such as the costs of outpatient procedures performed during the year after surgery. The 1-year follow-up, as recognized by the authors, is also likely not sufficient to determine the true cost-effectiveness of ACDF vs MIPCF because many of the MIPCF patients may later require a reoperation at the index level.Our review of the literature is equivocal regarding the superiority of MIPCF over ACDF for single-level unilateral cervical radiculopathy. Aggregate data from several meta-analyses consistently report significantly shorter length of stay with MIPCF compared with ACDF, but do not demonstrate superior