Comparative Outcomes of Single-Level Lumbar Laminectomy versus Hemilaminectomy: A Retrospective TriNetX Analysis

Study DesignRetrospective Cohort Study.ObjectivesTo compare 1-year postoperative outcomes and complication rates between single-level lumbar laminectomy and hemilaminectomy using a large, multicenter, propensity-matched dataset.MethodsWe 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.ResultsOf 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; <i>P</i> = 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.ConclusionsHemilaminectomy 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.