Laminoplasty Associated With a Lower Risk of Reoperation Compared to Laminectomy/Fusion for Multilevel Posterior Cervical Spine Surgery
Spine · 20 Jul 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
This is one of the largest comparative cohorts on posterior cervical decompression strategy and adds long-term reoperation data to an ongoing debate about laminoplasty versus laminectomy/fusion for multilevel cervical myelopathy.
The evidence
This retrospective cohort study used a US multicentre spine registry to compare 1,294 patients who had posterior cervical laminoplasty (PCL) with 3,118 who had posterior cervical laminectomy and fusion (PLF) for multilevel cervical spondylosis. Over a median follow-up of 4.7 years, adjusted analyses showed PCL was associated with lower risk of reoperation for adjacent segment disease (HR 0.42, 95% CI 0.22-0.82) and lower risk of all-cause reoperation (HR 0.51, 95% CI 0.33-0.79), with no differences in mortality, 90-day ED visits, or 90-day readmissions.
operative adjacent segment disease (ASD): Hazard ratio 0.42 (95% CI 0.22 to 0.82; units not reported). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Registry cohort (adjusted)
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot met
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- 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.Given the large imbalances in myelopathy diagnosis, spondylolisthesis, and number of levels between groups (SMD as high as 1.195), how confident can we be that multivariable adjustment fully accounted for confounding by indication in choosing PCL versus PLF?
2.If your institution predominantly performs PLF for multilevel cervical spondylotic myelopathy, would this registry data alone be enough to shift your practice toward laminoplasty, or would you want patient-reported outcome and alignment data before changing technique?
Original publication title
Laminoplasty Associated With a Lower Risk of Reoperation Compared to Laminectomy/Fusion for Multilevel Posterior Cervical Spine Surgery