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.

Abstract

Study designSystematic review and meta-analysis.ObjectiveThis 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.MethodsA 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.ResultsTwelve 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%).ConclusionLF incurred greater costs but provided superior pain relief. Significant heterogeneity and limited high-quality evidence highlight the need for further research on cost-effectiveness and patient-centered outcomes.