Revisiting the Incidence and Risk Factors for Cervical Postlaminectomy Kyphosis: A Systematic Review.
Abstract
STUDY
Design
Systematic review.
Objective
To perform a systematic review that investigates the incidence and risk factors for cervical postlaminectomy kyphosis. SUMMARY OF
Background
DATA There is a wide range of incidences and risk factors for cervical postlaminectomy kyphosis reported within the literature. Definitive recommendations on indications and technical considerations to minimize this complication remain elusive.
Methods
A systematic review was registered with PROSPERO and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All level I-III evidence studies investigating radiologic outcomes after cervical laminectomy for compressive pathology of the cervical spine were included.
Results
Twenty studies with 1538 patients (1007 males, 531 females) were included. Extensive laminectomy (≥4 laminae) was performed in 746 patients (48.5%), selective laminectomy (<4 laminae) in 275 patients (17.9%), and skip laminectomy in 43 patients (2.8%). A non-muscle-sparing technique was performed in 726 patients (47.2%) and a partial or complete interspinales and/or semispinalis cervicis muscle-sparing technique was performed in 338 patients (22.0%). Postoperative radiologic follow-up was available in 1198 patients (77.9%). Patients undergoing extensive laminectomy had a significantly higher rate of postlaminectomy kyphosis compared with selective or skip laminectomy (15.3% vs. 3.5%, P<0.001). Patients undergoing non-muscle-sparing laminectomy also had a higher rate of postlaminectomy kyphosis at final follow-up compared with partial or complete muscle-sparing laminectomy (13.8% vs. 5.3%, P<0.001).
Conclusions
The incidence of cervical postlaminectomy kyphosis varies widely, and the risk factors are multifactorial. Performing selective laminectomies and maximally preserving the attachments of the interspinales and/or semispinalis cervicis may be important considerations for preventing this complication. LEVELS OF EVIDENCE Level III-systematic review of level I-III studies.