Trends in laminoplasty versus posterior cervical fusion in the United States: a retrospective analysis from 2015 to 2023.

BACKGROUND CONTEXT: Degenerative cervical myelopathy is commonly treated with posterior cervical fusion (PCF) or cervical laminoplasty in multilevel disease; comparative effectiveness is similar in selected patients, yet real-world utilization and cost patterns remain unclear.

PURPOSE: To characterize national trends, case mix, socioeconomic profiles, and payments for laminoplasty versus PCF from 2015 to early 2023.

STUDY DESIGN/

SETTING

Retrospective cohort study using a national administrative claims database.

PATIENT SAMPLE: Adults (≥18 years) undergoing cervical laminoplasty or PCF between 2015 and early 2023 (n=77,514; laminoplasty n=5,581; PCF n=71,933).

OUTCOME MEASURES: Annual utilization, demographics, comorbidities (Elixhauser index and specific conditions), ZIP code-linked socioeconomic indicators (mean family income, high-school graduation rate), average payments, and total national expenditures.

METHODS

Procedures were identified using Current Procedural Terminology and ICD-9/10 codes within the PearlDiver Mariner 165 database. Descriptive statistics summarized characteristics; χ² tests compared categorical variables, and t tests/Welch or Mann-Whitney tests compared continuous variables. Significance threshold was p<.05.

RESULTS

Laminoplasty remained a small proportion of posterior procedures, whereas PCF accounted for the majority of cases (laminoplasty: n=5,563; PCF: n=71,660). Socioeconomically, laminoplasty patients came from higher-income ZIP codes than PCF patients ($82,520 vs $80,945) and had slightly higher high school graduation rates (88.2% vs 88.0%, both p≤.005). PCF was associated with higher mean professional payment per case ($3,786 vs $1,455) and substantially greater total national professional expenditure ($271.3M vs $8.09M).

CONCLUSIONS

From 2015 to early 2023, PCF predominated and grew, while laminoplasty remained a small, stable minority of posterior decompressions. Laminoplasty patients had lower comorbidity but higher obesity and slightly higher socioeconomic indicators. Fusion received higher per-case payments and drove far greater spending, suggesting selection and reimbursement dynamics that may limit access to motion-preserving surgery.