Trends in laminoplasty versus posterior cervical fusion in the United States: a retrospective analysis from 2015 to 2023.
Publication/Presentation Date
7-1-2026
Abstract
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.
Volume
26
Issue
7
First Page
1264
Last Page
1270
ISSN
1878-1632
Published In/Presented At
Yusupov, D., Champigneulle, O., Johnson, M., Budin, J. S., Xavier, J., Mastrokostas, L. E., Mastrokostas, P. G., Varthi, A., Vaccaro, A. R., Schroeder, G. D., Kepler, C. K., Monsef, J. B., Razi, A. E., & Ng, M. K. (2026). Trends in laminoplasty versus posterior cervical fusion in the United States: a retrospective analysis from 2015 to 2023. The spine journal : official journal of the North American Spine Society, 26(7), 1264–1270. https://doi.org/10.1016/j.spinee.2026.02.002
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
41713749
Department(s)
Administration and Leadership
Document Type
Article