Laminoplasty — a cervical spine procedure that expands the spinal canal and relieves cord compression without fusing any vertebrae — is motion-preserving, well-established in Asia and Europe and supported by long-term outcomes data, Siamak Yasmeh, MD, a spine surgeon at DISC Tarzana (Calif.) and DISC Marina del Rey (Calif.), told Becker’s.
It is also performed in just 0.4% of cervical spine cases in the United States, according to a report by the American Spine Registry, a gap that Dr. Yasmeh is working to close with his adoption of the procedure.
Dr. Yasmeh’s practice focuses on minimally invasive techniques, motion preserving techniques, which often means exhausting non-operative options before recommending surgery and avoiding fusion whenever a better option exists.
“I wouldn’t want a fusion if I didn’t need it,” he said. “I want to preserve motion, because activity is really important to life. You want to be able to keep doing sports or other hobbies, and you don’t want to be tied down by a fusion if necessary.”
Laminoplasty, in his view, is that better option for many patients with multilevel cervical stenosis — a narrowing of the spinal canal in the neck that, when severe, compresses the spinal cord and can cause significant neurological symptoms. The procedure expands the canal from behind without fusing any vertebrae, preserving motion in the neck. That distinction matters less in the short term — fused patients generally do well — than over the long run.
“If you fuse someone’s neck, they can do very well. They will lose a little bit of motion, but they still do well,” he said. “The biggest downside is that over time, when you fuse a neck, the areas above and below the fusion will develop degenerative changes, and so they’ll develop the problem again. About 25% of people develop the same issue again within 10 years, and if you push it out longer, 20 years it becomes 50%, 30 years it becomes 75%. When you do a laminoplasty and you don’t have to fuse, you essentially avoid that risk. You can tell this person most likely this will be the one and only surgery you need.”
The cost picture aligns with that long-term argument. Research published in Spine in 2024 found that total facility costs for cervical laminoplasty were lower than for laminectomy with fusion.
While laminoplasty’s cost-savings potential and positive patient outcomes position is squarely within a value-based care framework, the position has lagged adoption in the U.S.
“There is a training gap,” Dr. Yasmeh said. “When a spine surgeon is being trained, you essentially get trained on whatever your mentors are comfortable with and what they do in practice. There’s a big resistance to trying new things.”
The procedure arrived in the US when a small number of surgeons traveled to Asia — where laminoplasty has been performed for decades and is widely adopted — trained for several months, and returned to teach others. The knowledge base grew slowly, and the surgeons most positioned to pass it on were those already deep into established practices.
“You can imagine if you’re a spine surgeon who’s 20 or 30 years in practice and you’re training the next generation. You’re really comfortable with everything you’re doing, and it becomes very, very challenging to then start a new procedure,” he said. “I think what it takes to bridge the gap is more people seeking out that training in addition to their typical spine fellowship.”
Laminoplasty, like most spine procedures, depends heavily on small technical details that are typically passed from mentor to trainee in a fellowship setting, Dr. Yasmeh said.
“Unless you have someone who’s kind of taught you the tips and tricks — if you go out and practice and try to do a surgery you’ve never done before — typically things don’t go well,” he said. “It has this tremendous potential to help patients, and there is this kind of training deficit for newer surgeons. There needs to be some sort of push for them to get exposure so they can become comfortable doing it, and they can then go on to teach other people.”
The same instinct toward motion preservation shapes how Dr. Yasmeh approaches patients outside the operating room. He counts reformer Pilates and deadlifting among the most common exercise-related causes of back pain he sees in clinic — not because the activities are inherently harmful, but because they place significant load on the discs without the muscle conditioning to support it. His preference is modification and strengthening, not avoidance.
“Rather than say you can’t lift weights, you can’t do Pilates, we have to work on some modifications to maybe decrease the risk of further injury, and then work on strengthening the muscles that support the spine,” he said.
Looking further out, Dr. Yasmeh sees AI as the next meaningful inflection point for spine surgery — less as a tool to improve surgical execution and more as a way to solve a problem that remains stubbornly difficult even for experienced surgeons: predicting which patients will not do well.
For Dr. Yasmeh, laminoplasty fits squarely into that same philosophy — do more with less, and avoid creating downstream problems that require additional intervention. A procedure that preserves motion, avoids the hardware costs of fusion and dramatically reduces the likelihood of a second surgery is, by definition, a value-based care story.
“You can tell this person most likely this will be the one and only surgery you need,” he said. “You’re not gonna have to come back and get another fusion 10 years down the line.”
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