Complication Rates After Cervical Laminectomy and Fusion Versus Cervical Laminoplasty in Patients of Advanced Age

Study Design: Retrospective cohort study. Objective: To compare the complications following cervical laminectomy with instrumented fusion (LF) versus cervical laminoplasty with reconstruction (LP) in patients of advanced age within a single surgeon cohort. Summary of Background Data: The prevalence of cervical spondylotic myelopathy (CSM), the most common cause of spinal cord dysfunction in adults, increases with advanced age. CSM is often effectively treated with one of a variety of surgical procedures, with the prevalent posterior options including laminectomy and fusion or laminoplasty. Both of these procedures have been associated with increased morbidity and mortality in the elderly population. However, the risks of laminectomy and fusion versus laminoplasty have not yet been fully compared with each other as a function of age. The magnitude of the increased risk remains unclear. The purpose of this study was to assess the effects of advancing age in CSM patients undergoing either cervical laminectomy and fusion or laminoplasty within a single surgeon cohort. Methods: This study retrospectively identified patients undergoing primary laminectomy and fusion or laminoplasty procedures indicated for CSM in a single surgeon cohort (2004–2023). Data from the patients’ medical background, procedure, inpatient hospital admission, and outpatient follow-up were collected. Patients were subdivided into those younger than 65 years of age and those 65 years of age or older for analysis. Multivariable logistic regression was then utilized to analyze the relationship between age group and a variety of endpoints, including the rate of adverse events, reoperation rates within 1 year, ongoing opioid use, and peripheral nerve injury. Results: In our cohort of 365 patients, the age group had no influence on which procedure was performed, laminectomy and fusion versus laminoplasty ( P =0.91). Across all ages, when compared with laminectomy and fusion, laminoplasty was associated with significantly lower odds of having an adverse postoperative event [OR=0.12 (0.04–0.39), P =0.001], a complication [OR=0.08 (0.02–0.35), P =0.001], a peripheral nerve injury [OR=0.08 (0.01–0.73), P =0.03], or using opioids past 6 months postoperative [OR=0.17 (0.06–0.46), P =0.001]. Interestingly, the younger laminectomy and fusion group had significantly higher odds of postoperative adverse events when compared with the elderly laminoplasty group (17.5% vs. 4.6%, P =0.01), despite a lower prevalence of medical comorbidities. Conclusions: Findings from our retrospective cohort support the implementation of cervical laminoplasty as a safe treatment option in patients of advanced age with cervical spondylotic myelopathy. Data from our population suggest that cervical laminoplasty, in appropriately selected patients, has a lower rate of adverse postoperative events, complications, and peripheral nerve injuries, as well as decreased likelihood of prolonged opioid use for patients across all age groups. Level of Evidence: Level III.