Incidence of Tetraplegia After Cervical Laminectomy Versus Laminoplasty: A Propensity Score Matched Analysis Using US Collaborative Network Database in TriNetX
Global Spine Journal · 7 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Tetraplegia after posterior cervical decompression is a rare but catastrophic complication, and these real-world incidence estimates and procedure comparisons can inform how surgeons counsel patients when choosing between laminectomy and laminoplasty.
The evidence
This retrospective database study used TriNetX to compare rates of postoperative tetraplegia between cervical laminectomy and laminoplasty in about 3,950 propensity-matched patients per group with degenerative cervical stenosis/spondylosis. Tetraplegia (almost always incomplete) was rare in both groups but occurred more often after laminectomy, especially at the C1-C4 level, where 12-month risk was 2.2% versus 1.1% with laminoplasty (OR 2.0, 95% CI 1.4-2.9); 12-month mortality was also higher after laminectomy (2.7% vs 1.6%, p=0.0004).
Tetraplegia (complete or incomplete), C1-C4: Odds ratio 2 (95% CI 1.4 to 2.9; units not reported). The interval favours the comparator; the size of the disadvantage needs clinical interpretation.
Why this rigour score?
Registry cohort (adjusted)
Methods at a glance
Recorded assessment- Confounding adjustmentPropensity scores
- Covariate balance confirmedMet
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerCalculation absent
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If laminectomy carries roughly double the risk of incomplete tetraplegia at C1-C4 compared to laminoplasty, should laminoplasty be preferentially considered for patients needing decompression at these upper cervical levels?
2.Given the higher 12-month mortality seen with laminectomy in this cohort, how should surgeons weigh unmeasured confounding by indication (e.g., patients selected for laminectomy with fusion, frailty, or more severe disease) when counselling patients about procedure choice?
Original publication title
Incidence of Tetraplegia After Cervical Laminectomy Versus Laminoplasty: A Propensity Score Matched Analysis Using US Collaborative Network Database in TriNetX