1. Aetna considers cervical laminoplasty (laminaplasty) medically necessary for members with severe cervical spinal stenosis at multiple (greater than or equal to 3) levels and compressive myelopathy.

2. Aetna considers cervical laminoplasty experimental and investigational for members with mechanical axial neck pain (cervical strain) without myelopathy, and for all other indications because its effectiveness for these indications has not been established.

Laminoplasty (laminaplasty) may be indicated in patients with myelopathy and multiple-level cervical spondylosis, such as in congenital cervical stenosis.  When cervical spinal stenosis is severe, various symptoms may develop which include pain, weakness in arms and/or legs and unsteadiness in the gait (myelopathy).

For mild conditions conservative treatment may be sufficient.  When symptoms are severe or progressive then a surgical treatment may be necessary.  Surgical goals include a decompression of all compressed levels of the spine and stabilization with solid fusion.  Surgical techniques are very dependent upon the specific problems of each patient.  Anterior and posterior surgical approaches can be applied.  In certain cases a decompression laminoplasty without fusion may be employed.  Laminoplasty consists of a careful splitting of the laminae, which are then held apart in order to enlarge the spinal canal diameter.  The procedure involves opening and fusion of the cervical spinal canal.

In a retrospective study, Sakaura and colleagues (2005) compared the long-term outcomes after laminoplasty and anterior spinal fusion (ASF) for patients with cervical myelopathy secondary to disc herniation.  The authors concluded that because the 2 procedures provided the same neurological improvement, the risks of bone graft complication with ASF must be weighed against the risks of chronic neck pain associated with laminoplasty for determining the best technique.  For these investigators, laminoplasty is the procedure of choice for cervical myelopathy due to disc herniation except for patients with single-level disc herniation without developmental canal stenosis, who are considered to be good surgical candidates for ASF.

Ohnari et al (2006) noted that cervical laminoplasty is a good strategy for cervical myelopathy, but some post-operative patients complain of obstinate axial symptoms after surgery (i.e., nuchal pain, neck stiffness, and shoulder pain).  It was reported that these symptoms proved to be more serious than has been believed and should be considered in the evaluation of the outcome of cervical spinal surgery.  However, axial symptoms are sometimes recognized before surgery, or also after corpectomy.  These investigators examined the difference in axial symptoms before and after laminoplasty and discussed the characteristics of these symptoms as a surgical complication.  They conducted a questionnaire survey and reviewed the medical records of respondents.  A total of 180 patients who underwent a spinous process-splitting laminoplasty for cervical myelopathy caused by degenerative disease in the authors’ institution from 1993 until 2002 were included in the study, and were followed-up for 2 years or longer after surgery.  Major outcome measures were self-report measures and functional measures.  The questionnaire elicited information as follows: the location and characteristics of pre- and post-operative symptoms, frequency and duration of post-operative symptoms, and impairment in activities of everyday living, analgesic use, and the duration of use of cervical orthosis after surgery.  The researchers divided axial symptoms into 4 characteristics based on previous reports: (i) pain, (ii) heaviness, (iii) stiffness, and (iv) other.  An illustration of the upper back on which respondents could mark each characteristic was used to acquire information about the location of axial symptoms.  The following information was gathered from medical records and statistically analyzed: whether post-operative axial symptoms were related or not, age, sex, neurological findings, the period of cervical orthosis, surgery time, blood loss, with or without reconstruction surgery of the semi-spinalis cervicis muscle, and pre-operative axial symptoms.  For all of the 51 respondents, the average time since surgery was 4.1 years at the time of investigation; 42 patients complained of post-operative axial symptoms; 26 patients stated the duration of symptoms after surgery to be more than 2 years.  The surgical outcome of this group, however, did not differ from that of the 2-year-or-less group.  Axial symptoms, which accounted for 13.3 % of all answers about post-operative impairment of everyday living, were similar to hand numbness.  Of respondents with post-operative axial symptoms, 52.2 % stated the frequency of affliction to be "all day long", but 34.8 % replied "rarely" to frequency of use of analgesics.  Axial symptoms in the nuchal region increased from 45.2 % to 48.6 % after surgery.  Stiffness was the most common characteristic before and following surgery, but pain significantly increased from 24.6 % before surgery to 38.4 % after surgery.  It was speculated that the principal manifestation of axial symptoms might be pain and that the nuchal region might be the predominant region for axial symptoms.  There was no significant difference in age, blood loss, operative time, sex, duration of use of cervical orthosis, reconstructive surgery, and pre-operative symptoms between 2 groups -- those who complained of axial symptoms after surgery, and those who did not.  The authors concluded that axial symptoms were not usually so severe as to require analgesic use and did not worsen the Japanese Orthopedic Association score after surgery; symptoms were, however, considered to continuously affect everyday life as much as hand numbness.  Regarding their features, the authors speculated that the main characteristics of axial symptoms might be pain and that the nuchal region might be the predominant region for axial symptoms.  These findings are consistent with the hypothesis that laminoplasty is not, as such, an effective treatment for axial neck pain and that axial symptoms may in fact be worsened by the procedure.

The Work Loss Data Institute's clinical practice guideline on "Neck and upper back (acute & chronic)" (2011) stated that a relative contraindication to laminoplasty is pre-operative neck pain as disruption of the musculature can aggravate axial pain.