Laminoplasty Associated With a Lower Risk of Reoperation Compared to Laminectomy/Fusion for Multilevel Posterior Cervical Spine Surgery: A Cohort Study of 4,412 Patients.

STUDY

DESIGN

Retrospective Cohort Study.

OBJECTIVE

To compare multilevel posterior cervical laminoplasty (PCL) versus multilevel posterior cervical laminectomy and fusion (PLF) in a US-based cohort, hypothesizing outcomes would differ by approach.

SUMMARY OF BACKGROUND DATA: Posterior approaches to the cervical spine are versatile and comprehensive means of addressing operative pathology.

METHODS

Using data from a US-based healthcare system's multicenter spine registry, adult patients who underwent primary posterior only cervical surgeries involving ≥2 levels between C3-T2 were identified (2009-2023). Operative adjacent segment disease (ASD) was evaluated longitudinally. Secondary outcomes included operative non-union, reoperation for any reason, and mortality, also evaluated longitudinally, as well as 90-day emergency department (ED) visit and 90-day readmission. Multivariable Cox proportional hazards for longitudinal outcomes and logistic regression for binary outcomes were used with adjustment for covariates and operating surgeon.

RESULTS

The study included 4,412 patients, 1,294 (29.3%) with PCL. Mean age (64.2 vs 65.2 y), gender (36.9% vs 41.7% female), and BMI (29.0 vs 29.1 kg/m2) were similar between PCL and PLF groups, respectively; while imbalance was observed in the distribution of myelopathy diagnosis, spondylolisthesis diagnosis, number of levels involved, and operative time. In adjusted analyses, PCL was associated with a lower risk of operative ASD (hazard ratio [HR]=0.42, 95% confidence interval [CI]=0.22-0.82) compared to PLF. A lower risk for all-cause reoperation (HR=0.51, 95% CI=0.33-0.79) was also observed for PCL compared to PLF, while no differences were observed in mortality (HR=0.81, 95% CI=0.62-1.06), 90-day ED visits (odds ratio [OR]=0.84, 95% CI=0.67-1.05), or 90-day readmissions (OR=0.84, 95% CI=0.63-1.11).

CONCLUSIONS

In this large cohort, multilevel PCL was associated with a lower risk of operative ASD and overall reoperation compared to PLF. Further studies should explore why PLF is selected at more than twice the rate of PCL despite the higher reoperation risks observed in the present cohort.