Laminoplasty vs Laminectomy and Fusion for Cervical Myelopathy: Alarming Rates of Bias

Study DesignCross-sectional.ObjectivesLaminoplasty (LP) and laminectomy with fusion (LF) are surgical approaches for degenerative cervical myelopathy (DCM), but their comparative effectiveness remains controversial. Systematic reviews and meta-analyses are crucial for guiding clinical decision-making; however, spin bias, which distorts results and misleads readers, is prevalent in the orthopaedic literature, and can hinder clinical decision making. We aim to determine the prevalence of spin bias and assess the methodological quality of systematic reviews and meta-analyses comparing LP with LF in the treatment of DCM.MethodsWe systematically searched the PubMed, Web of Science, and Embase databases, identifying systematic reviews and meta-analyses comparing LP and LF for DCM. Spin bias was assessed using the Yavchitz classification system, and methodological quality was graded using the AMSTAR-2 tool.ResultsFourteen studies met the inclusion criteria. Spin bias was identified in 64% of the reviews, with the most common type being Type 9 (inappropriately claiming superiority of treatment despite reporting bias). Spin types 3, 4, and 6 were each present in 14% of studies. AMSTAR-2 quality assessments rated 21% of studies as critically low, 36% as low, and 43% as moderate; none achieved a high-quality rating.ConclusionSpin bias is prevalent in systematic reviews and meta-analyses comparing LP and LF for DCM, and the overall methodological quality remain suboptimal. Addressing spin bias and improving adherence to rigorous reporting standards are essential to enhance the reliability of evidence guiding clinical decision-making.