Prevalence of axial symptoms after posterior cervical decompression: a meta-analysis

To investigate the prevalence of axial symptoms (AS) in patients following posterior cervical decompression.

We searched the PubMed, Embase, and Cochrane databases for relevant studies that reported the incidence of AS after posterior cervical decompression, and manually screened reference lists for additional studies. Relevant prevalence estimates were calculated. Subgroup analysis, sensitivity analysis and publication bias assessment were also performed.

Our meta-analysis included 44 studies, with 893 AS cases in 2984 patients. The pooled AS prevalence was 28 % (95 % CI 24-32). The prevalence of AS was higher after expansive open-door laminoplasty (39 %) than after modified open-door laminoplasty (MOLP, 23 %) and laminectomy instrumented fusion (29 %). AS prevalence was also higher in those that wore a neck collar for 2-3 months (34 %) compared with 2 weeks (21 %). The lowest AS prevalence (9 %) was found in patients who underwent MOLP with C3 laminectomy and C7 spinous processes conserved. There was an intermediate AS prevalence after MOLP with C7 spinous processes conserved (16 %), MOLP with preservation of the unilateral posterior muscular-ligament complex (19 %), MOLP with C3 laminectomy (22 %), and MOLP with plate fixation (23 %). Prevalence of AS might be higher in patients <60 years and increased in populations with a higher proportion of females.

Posterior cervical surgery carries a high risk of postoperative AS. Postoperative AS may be reduced through preserving posterior muscles and structures, stabilizing cervical vertebrae, and reducing external cervical immobilization time.