1226 Laminoplasty Offers Similar Initial Improvement, but Better Long-Term Improvement Between 12 and 24 Months vs ACDF and PCF: A Quality Outcomes Database Study

INTRODUCTION: Despite its distinct advantages, laminoplasty remains relatively underexplored in comparison to ACDF and PCF regarding long-term patient reported outcome measures (PROMs). METHODS: The Quality Outcome Database was queried for patients who underwent ACDF, PCF or laminoplasty. Primary exposure variable was laminoplasty versus ACDF/PCF. Outcome were difference in improvement in PROMs at 12, and 24 months; operative blood loss; and length of stay. Linear regression models were fitted for PROMs. RESULTS: Of 2977 patients included (mean age 60.9±11.3; 51.1% male), 2270 (76.3%) underwent ACDF, 643 (21.6%) PCF and 64 (2.1%) laminoplasty. At 12-months, PCF patients had greater arm pain improvement than laminoplasty patients (β=1.08, 95%CI=0.21-1.94, p=0.015). ACDF patients had greater improvements in neck pain (β=0.61, 95%CI=0.34-0.88, p<.001), arm pain (β=0.42, 95%CI=0.13-0.72, p=0.005), and NDI (β=6.31, 95%CI=2.03-10.58, p=.004) but worse improvement in EQ5D (β=-0.07, 95%CI=-0.12--0.02, p=0.008) than laminoplasty patients. At 24-months, there was no significant difference in improvements between laminoplasty patients and ACDF/PCF patients (all p>0.05). Between 12 and 24 months, laminoplasty patients had greater improvement in neck pain (0.7±0.6 vs. 0.1±0.2 vs. -0.1±0.1), arm pain (1.1±0.7 vs. -0.0±0.2 vs. -0.1±0.1), and NDI (1.9±3.3 vs. -0.5±1.1, -0.9±0.6) than PCF and ACDF patients. Laminoplasty patients were predicted to have less blood loss (EMM=145.7±17.6, p=.012) and length of stay (IRR=0.81, 95%CI=0.69-0.95, p=.012) than PCF patients. CONCLUSIONS: Laminoplasty patients demonstrated worse neck pain, arm pain, NDI but better EQ5D improvement than ACDF and comparable improvements to PCF patients by 12-months. Importantly, between 12-24 months, laminoplasty patients achieved improvement in all PROMs whereas ACDF and PCF patients plateaued, suggesting that laminoplasty may offer better long-term improvement in PROs when compared to ACDF and PCF patients.