Study Design Retrospective Cohort Study. Objectives To compare 1-year postoperative outcomes and complication rates between single-level lumbar laminectomy and hemilaminectomy using a large, multicenter, propensity-matched dataset. Methods We queried the TriNetX global health research network (≥160 million patients) for adults undergoing single-level lumbar decompression between January 2005 and July 2025. Cohorts were defined by CPT codes: laminectomy and hemilaminectomy, with qualifying diagnoses of lumbar disc herniation, spinal stenosis, spondylolisthesis, or radiculopathy. Patients with fusion, prior lumbar surgery, or non-degenerative pathology were excluded. Outcomes included new postoperative events within 1 year: mortality, weakness, pain, sensory loss, cauda equina syndrome, radiculopathy, foot drop, CSF leak, and surgical-site infection. Propensity-score matching balanced demographics and comorbidities. Cox proportional hazards models, Kaplan–Meier curves, and relative risks were calculated. Results Of 167,177 patients, 80,440 underwent laminectomy and 86,737 hemilaminectomy. After matching, 50,853 patients per cohort were analyzed. One-year mortality was similar (0.57% vs 0.49%, HR 1.20; 95% CI 1.01-1.42; P = 0.045). Laminectomy conferred significantly higher risks of CSF leak (1.41% vs 1.00%; RR 1.41), surgical-site infection (1.45% vs 1.00%; RR 1.45), cauda equina syndrome (0.36% vs 0.22%; RR 1.62), and persistent weakness (4.12% vs 3.67%; RR 1.12). Persistent radiculopathy was modestly less frequent after laminectomy (10.5% vs 12.0%; RR 0.87). Other outcomes, including pain and foot drop, were comparable. Conclusions Hemilaminectomy was associated with lower perioperative complication rates compared to laminectomy, while laminectomy provided a modest reduction in persistent radiculopathy. These findings highlight a tradeoff between safety and decompressive efficacy, emphasizing the importance of patient-specific surgical selection.
Sollenberger et al. (Thu,) studied this question.