Laminoplasty Associated With a Lower Risk of Reoperation Compared to Laminectomy/Fusion for Multilevel Posterior Cervical Spine Surgery

This retrospective registry-based cohort study followed 4,412 adults who had multilevel posterior cervical spine surgery (2009-2023) at a large US integrated health system, comparing laminoplasty (PCL, 29.3%) to laminectomy with fusion (PLF, 70.7%). After adjusting for patient and surgical factors, PCL was associated with a lower risk of reoperation for adjacent segment disease (hazard ratio 0.42) and lower all-cause reoperation (hazard ratio 0.51) over a median 4.7 years of follow-up, with no difference in mortality, 90-day ED visits, or readmissions.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersThis large, long-term comparison adds weight to the argument that laminoplasty should be considered more often than laminectomy/fusion for multilevel cervical spondylotic myelopathy, a debate residents will encounter on spine rotations and boards.

Presenting this at rounds? Start here

• ?Given the significant baseline imbalances in myelopathy diagnosis, spondylolisthesis, number of levels, and operative time between groups, how confident can we be that multivariable adjustment fully accounts for confounding by indication in choosing PCL versus PLF?
• ?If you were counseling a patient with multilevel cervical myelopathy and preserved sagittal alignment, would this study's reoperation data alone be enough to favor laminoplasty over laminectomy/fusion, or would you want patient-reported outcome and alignment data before changing your usual approach?