The Cost of Laminoplasty Versus Laminectomy and Fusion
A cost comparative analysis found that laminectomy and fusion has a significantly higher short-term cost than laminoplasty in patients with spondylotic myelopathy. Should laminoplasty, therefore, be the procedure of choice in appropriately indicated patients?
Laviel Fernandez, MD, and Peter Passias, MD
Goh B, Striano B, Lopez W, et al. Laminoplasty versus laminectomy and fusion for cervical spondylotic myelopathy: a cost analysis. Spine J. 2020 Nov;20(11):1770-1775. doi: 10.1016/j.spinee.2020.07.012. Epub 2020 Jul 28.
Cost is rarely a factor in whether a surgeon recommends laminoplasty or a laminectomy and fusion for a patient with cervical spondylotic myelopathy. Surgeon preference and individual patient factors hold sway.
Because they wanted to better understand the financial implications of the 2 procedures, Goh et al conducted a retrospective cost comparative analysis of laminoplasty versus laminectomy and fusion among adult patients with cervical spondylotic myelopathy who underwent either procedure between 2017 and 2019 at 2 academic institutions.
The primary outcome measure was total cost, which included implant and non-implant-related costs. Secondary outcome measures were patient demographics, estimated blood loss, operative time, and length of stay. After stratification, a total of 250 patients were available for analysis.
The researchers observed no statistically significant difference between the 2 groups in age at time of original operation, sex, or reoperation rate. Operative time was similar for both groups as well. The laminoplasty group had a shorter length of stay: 3.8 +/- 2.7 days, compared with 4.8 +/- 3.7 days for the laminectomy and fusion group.
The most significant finding was that the total cost for laminectomy and fusion was 2.4 times higher than for laminoplasty. When adjusted based on operated level, the cost for laminectomy and fusion was 2.3 higher than for laminoplasty.
Cervical spondylotic myelopathy is a major source of neurologic dysfunction in the adult population. Prior literature has demonstrated equivalent results between laminoplasty and laminectomy and fusion in addressing the cord compression that occurs in cervical spondylotic myelopathy. Each procedure has its own advantages and disadvantages, but a comparative analysis of the costs of the procedures has been lacking.
The findings of the study by Goh et al demonstrate a significant cost difference between laminoplasty and laminectomy and fusion. In addition, patients who undergo laminectomy and fusion had a statistically significant greater length of stay compared with those who underwent laminoplasty, which further adds to the increased cost of laminectomy and fusion.
Although the results of this study suggest that laminoplasty should have stronger consideration from a cost savings perspective in appropriately indicated patients, the follow-up period was only 6 months. Therefore, it is still unclear if, with longer-term follow-up, patients in the laminoplasty group would have a higher reoperation rate than those in the laminectomy and fusion group, which would minimize the cost savings.
Longer-term studies analyzing differences in the reoperation rates beyond 6 months are needed to determine whether the cost savings pattern observed in this study is maintained.
Laviel Fernandez, MD, is an orthopaedic surgery resident, NYU Langone Medical Center – Langone Orthopedic Hospital, New York, New York. Peter Passias, MD, is a Clinical Associate Professor of Orthopaedic Surgery, Division of Spine Surgery, Department of Orthopaedic Surgery, at NYU Langone Medical Center – Langone Orthopedic Hospital, New York, New York.
Disclosures: The authors have no disclosures relevant to this article.