Study design Systematic review and meta-analysis. Objective This systematic review and meta-analysis compared cervical laminoplasty (LP) with laminectomy and fusion (LF) for the treatment of degenerative cervical myelopathy (DCM), focusing on healthcare costs and patient-centered outcomes. Methods A systematic review of EMBASE and Medline (inception to September 2024) identified studies comparing LP and LF for multilevel DCM. Outcomes included return-to-work (RTW), direct treatment costs, and changes in pain and opioid use. Meta-analyses were performed using random-effects models to estimate pooled mean differences (MD) between treatment arms and mean per treatment for study outcomes. Study quality was assessed with the Newcastle-Ottawa Scale. Results Twelve retrospective cohort studies (7581 patients; LP: 1, 848, LF: 5733) met inclusion criteria. After appraising the included studies, we determined that 25% were of high quality, 67% were of moderate quality, and 8% were of low quality. LF had higher treatment costs (74, 772. 8 USD, 95% CI 29, 503. 72-120, 041. 88) than LP (52, 109. 07 USD, 95% CI 12, 234. 14-91, 985. 43), with an MD of −21, 620. 69 USD (95% CI −35, 215 to −8025. 53, I 2 = 95%). LF led to greater pain reduction (MD in VAS = 1. 60, 95% CI 0. 36-2. 84, I 2 = 63%). Opioid use was inconsistently reported, preventing meta-analysis. One study found higher RTW rates at 12 months for LP (88. 9%) vs LF (64. 3%). Conclusion LF incurred greater costs but provided superior pain relief. Significant heterogeneity and limited high-quality evidence highlight the need for further research on cost-effectiveness and patient-centered outcomes.
Karthikeyan et al. (Thu,) studied this question.