Hemilaminectomy vs. laminectomy for spinal tumors: a systematic review and meta-analysis

Hemilaminectomy is a less invasive surgical option than laminectomy for spinal tumors, but which method provides better results remains to be determined. Thus, we aimed to perform a meta-analysis comparing outcomes between the two approaches. We searched PubMed, EMBASE, and Web of Science for studies comparing hemilaminectomy to laminectomy in patients who underwent spinal tumor resection until August 2024. The outcomes were total resection rate, neurological deterioration, postoperative complications, length of stay, operative time, and estimated blood loss. Statistical analysis was performed via R software (version 4.4.1). Heterogeneity was assessed with I² statistics. We included 12 studies with 1047 patients, of whom 405 (38.7%) underwent hemilaminectomy. The mean age was 56.6 ± 7.5 years. The mean follow-up ranged from 1 to 60 months. Among the tumors, 44.8% were meningiomas, and 57.4% were located in the thoracic spine. With no significant difference between hemilaminectomy and laminectomy in terms of the total resection rate achieved (RR 1.04, 95% CI: 0.98-1.11, I² = 38%), hemilaminectomy showed lower neurological deterioration (RR 0.53, 95% CI: 0.35-0.81, I² = 0%) and postoperative complications (RR 0.58, 95% CI: 0.39-0.86, I² = 12%). Furthermore, the length of stay (MD -2.91 days, 95% CI: -4.98 to -0.85; I² = 90%), operative time (MD -26.44 min, 95% CI: -46.22 to -6.67; I² = 61%), and estimated blood loss (MD -115.64 mL, 95% CI: -175.68 to -55.60; I² = 78%) were significantly lower in hemilaminectomy. Hemilaminectomy is associated with lower neurological deterioration, postoperative complications, operation time, length of stay, and estimated blood loss. Therefore, our results might suggest that hemilaminectomy may be a more promising and preferable alternative to laminectomy.