Cervical Laminoplasty is Associated with Lower Healthcare Costs as Compared to Cervical Fusion Procedures: A Systematic Review and Meta-Analysis of Comparative Studies

Introduction: Cervical laminoplasty (CLP) and cervical fusion (CF) are viable alternatives for surgical management of cervical spine pathology, with no clear consensus on clinical superiority. However, there is limited data on the relative costs between CLP and CF despite clinical equivalence in patient outcomes. The purpose of this study is to examine the cost of CLP versus CF stratified by approach to guide decision-making.

Methods: This systematic review and meta-analysis searched PubMed, CINAHL, MEDLINE, and Web of Science from database inception until January 17th, 2024. Inclusion criteria were articles that examined cost between CLP and any type of CF (stratified by anterior, posterior, or combined approach). Article quality was determined by the Methodological Index for Non-Randomized Studies (MINORS) scale. A random-effects continuous model for meta-analysis was performed using standardized mean difference (SMD) due to heterogeneity in reported costs with frequency-weighted means (FWM) to describe cost.

Results: Eleven retrospective articles were included out of 138 articles initially retrieved and determined to be low (n=2 articles) or moderate quality (n=9 articles). Patients (n=21,033) had an average age of 56.0 ± 3.6 years and underwent either CLP (n=4,364), posterior CF (n=3,529), anterior CF (n=13,084), or combined CF (n=56). There was a statistically significant lower reported cost among patients treated with CLP as compared to patients treated CF, irrespective of approach for CF (FWM: $19,931.90 versus $31,217.76; p=0.028; SMD=-2.990). For subgroup analysis by surgical approach, there was a statistically significant lower reported cost among patients treated with CLP as compared to patients treated with posterior CF (FWM: $18,060.64 versus $34,332.70; p=0.013; SMD=-1.861) and anterior CF (FWM: $20,562.33 versus $28,586.23; p< 0.001; SMD=-0.449), but not combined approach (FWM: $2,791.78 versus $5,835.58 p=0.063; SMD=-8.210) possibly due to being underpowered due to a small sample size.

Conclusion : CLP appears to be associated with statistically significant and clinically relevant lower reported costs as compared to CF, irrespective of approach based on meta-analysis of low or moderate quality retrospective studies. CLP may also have lower reported costs as compared to both posterior CF and anterior CF, although more data is needed for comparison between CLP and combined approach CF due to low power.