Spine Journal - 2026-07-01 - Journal Article; Comparative Study
Trends in laminoplasty versus posterior cervical fusion in the United States: a retrospective analysis from 2015 to 2023.
Yusupov D, Champigneulle O, Johnson M, Budin JS, Xavier J, Mastrokostas LE, Mastrokostas PG, Varthi A, Vaccaro AR, Schroeder GD, Kepler CK, Monsef JB, Razi AE, Ng MK
Topics
Key Takeaway
PCF accounted for 93% of posterior cervical procedures (n=71,933 vs n=5,581 laminoplasty) and generated 33× greater total professional expenditure ($271.3M vs $8.09M) from 2015 to 2023.
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Summary
This study used the PearlDiver Mariner 165 administrative claims database to characterize utilization, socioeconomic profiles, and payments for laminoplasty versus PCF from 2015 to early 2023. PCF dominated at 93% of posterior procedures and grew over the study period, while laminoplasty remained a small, stable minority. PCF commanded 2.6× higher per-case professional payment ($3,786 vs $1,455) and 33× greater total national expenditure, while laminoplasty patients had lower comorbidity burden but came from marginally higher-income ZIP codes.
Key Limitation
The absence of clinical data — including myelopathy severity, sagittal alignment, K-line classification, and surgeon training — prevents any determination of whether the PCF predominance reflects appropriate case selection or systematic overutilization driven by reimbursement incentives.
Original 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.