Introduction: Expansile multilevel laminectomies with instrumented fusion and laminoplasty have become more popular therapeutic options in cases of multilevel spinal stenosis with myelopathy. However, controversy still exists regarding the best posterior operative procedure to treat multilevel compressive cervical spinal stenosis with myelopathy. The primary aim of the study was to assess post-operative re-operation, 90-day complication rates and healthcare resource utilization following both posterior decompressive approaches.
Methods: Patients were selected from the Thomson Reuters’ MarketScan database based on the following inclusion criteria: all patients aged between 18 and 99 years undergoing either cervical laminoplasty or laminectomy with instrumented fusion procedure between 2000 and 2009. This database captures patient-level data on clinical utilization, insurance enrollment and links costs with detailed patient, provider and facility information. Propensity score modeling produced a matched cohort balanced on age, gender, comorbidity, and other relevant factors. Reoperation, 30- and 90-day post-operative complication rates, length of hospital stay, healthcare resources utilization, and total health-related costs were assessed. Univariate and multivariate analysis was used to compare outcomes following both procedures.
Results: 8,587 patients met our inclusion criteria, 946 (11.0%) of which had undergone laminoplasty. Two-year follow-up data was available for 3138 patients. Patients undergoing laminoplasty had a significantly lower complication rate during their index hospitalization (5.81% vs 9.62%, aOR: 0.556, 95% CI: 0.418-0.740, p<0.0002), and in the 90-day (aOR: 0.593, 95% CI: 0.460-0.764, p<0.0002) periods. Two-year re-operation rates were similar between both groups (9.77% vs. 7.36%, P=0.20). However, patients undergoing index laminoplasty patients had lower costs during their index hospitalization ($26129 vs $39653, p<0.0006), and overall during the two-year post-operative period ($77,960 vs $106,453, p<0.0001).
Conclusions: Posterior cervical laminectomy with fusion and laminoplasty result in similar two-year improvement in pain and functional status. However, decompressive laminectomy with fusion is more costly and is associated with higher 30- and 90-day post-operative complication rates.
Patient Care: This research will help surgeons better select amongst the available surgical options for posterior cervical decompression.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe outcome differences between laminectomy with instrumented fusion and laminoplasty for the treatment of cervical stenosis with myelopathy and 2) Better select surgical options for posterior cervical decompression.