Laminoplasty Versus Laminectomy and Fusion in the Treatment of Degenerative Cervical Myelopathy - A Systematic Review and Meta-Analysis of Cost and Patient-Centered Outcomes in the United States

Sep 30, 2026

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Systematic review and meta-analysis compared cervical laminoplasty (LP) with laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM), prioritizing healthcare costs and patient-centered outcomes. Searches of EMBASE and Medline (inception to September 2024) identified multilevel DCM studies reporting return-to-work, direct treatment costs, and pain/opioid use. Random-effects models pooled mean differences and mean per-treatment values, with study quality assessed using the Newcastle-Ottawa Scale.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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Abstract

Study design

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Laminoplasty Versus Laminectomy and Fusion in the Treatment of Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis of Cost and Patient-Centered Outcomes in the United States Global Spine Journal 2026, Vol. 16(1S) 43S-52S © The Author(s) 2025 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/21925682251357202](DOI: 10.1177/21925682251357202) [journals.sagepub.com/home/gsj](journals.sagepub.com/home/gsj) Vishwathsen Karthikeyan, MD 1,2,3 􀀁, Husain Shakil, MD1,2,3, Christopher S. Lozano, MD 1,2,3 􀀁, Armaan K. Malhotra, MD 1,2,3 􀀁 , Uzondu F. Agochukwu, MD4, Ankit I. Mehta, MD5 􀀁, C. Rory Goodwin, MD6 􀀁 , Nathan Evaniew, MD7, Paul A. Koljonen, MBBS8 􀀁, Allan R. Martin, MD9, James D. Guest, MD 10, Shekar N. Kurpad, MD 11, Jefferson R. Wilson, MD 1,2,3 􀀁 , and Aditya Vedantam, MD 11 􀀁 Abstract Study design: Systematic review and meta-analysis. Objective: This systematic review and meta-analysis compared cervical laminoplasty (LP) with laminectomy and fusion (LF) for the treatment of degenerative cervical myelopathy (DCM), focusing on healthcare costs and patient-centered outcomes. Methods: A systematic review of EMBASE and Medline (inception to September 2024) identiﬁed studies comparing LP and LF for multilevel DCM. Outcomes included return-to-work (RTW), direct treatment costs, and changes in pain and opioid use. Meta-analyses were performed using random-effects models to estimate pooled mean differences (MD) between treatment arms and mean per treatment for study outcomes. Study quality was assessed with the Newcastle-Ottawa Scale. Results: Twelve retrospective cohort studies (7581 patients; LP: 1,848, LF: 5733) met inclusion criteria. After appraising the included studies, we determined that 25% were of high quality, 67% were of moderate quality, and 8% were of low quality. LF had higher treatment costs ($74,772.8 USD, 95% CI $29,503.72-$120,041.88) than LP ($52,109.07 USD, 95% CI $12,234.14-$91,985 .43), with an MD of 􀀁$21,620.69 USD (95% CI 􀀁$35,215 to 􀀁$8025.53, I2 = 95%). LF led to greater pain reduction (MD in VAS = 1 .60, 95% CI 0.36-2.84, I2 = 63%). Opioid use was inconsistently reported, preventing meta-analysis. One study found higher RTW rates at 12 months for LP (88.9%) vs LF (64.3%). 1 Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada 2 Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada 3 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada 4 Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA 5 Department of Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA 6 Department of Neurosurgery, Spine Division, Duke University, Durham, NC, USA 7 Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada 8 Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China 9 Department of Neurological Surgery, University of California Davis, Davis, CA, USA 10 Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, USA 11 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA Corresponding Author: Aditya Vedantam, MD, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA. Email: [avedantam@mcw.edu](avedantam@mcw.edu) Creative Commons Non Commercial No Derivs CC BY-NC-ND: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ([https://creativecommons.org/l](https://creativecommons.org/l)icenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alterat

FAQs

What treatments does the study compare for degenerative cervical myelopathy?

The study compares cervical laminoplasty (LP) versus laminectomy and fusion (LF) for treating degenerative cervical myelopathy (DCM).

Which outcomes were included in the cost and patient-centered analysis?

Outcomes included return-to-work (RTW), direct treatment costs, and changes in pain and opioid use. Pain outcomes were synthesized using pooled mean differences, while opioid use was inconsistently reported.

What were the main findings regarding costs and pain relief?

LF had higher treatment costs than LP, while also leading to greater pain reduction based on VAS outcomes. RTW at 12 months was reported as higher for LP in one study.

Sep 30, 2026

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