Trends in Laminoplasty Versus Posterior Cervical Fusion in the United States: A Retrospective Analysis from 2015 to 2023.

Abstract

Degenerative cervical myelopathy (DCM) 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. To characterize national trends, case mix, socioeconomic profiles, and payments for laminoplasty versus PCF from 2015 to early 2023. Retrospective cohort study using a national administrative claims database. Adults (≥18 years) undergoing cervical laminoplasty or PCF between 2015 and early 2023 (N = 77,514; laminoplasty N = 5,581; PCF N = 71,933). 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. Procedures were identified using CPT 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 < 0.05. 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 ≤ 0.005). 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). 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.