Efficacy of Preventive Foraminotomy in Laminoplasty for Reducing Postoperative C5 Palsy: Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis compared laminoplasty with preventive C4–C5 foraminotomy against laminoplasty alone for preventing postoperative C5 palsy. Four retrospective studies involving 603 patients met the inclusion criteria. C5 palsy was less frequent with foraminotomy (OR=0.32; P =0.02), and Japanese Orthopedic Association score recovery was higher (P =0.002). Other reported outcomes, including radiologic measures and several complications, did not differ significantly; operation time was shorter with laminoplasty alone. The authors cautioned that the findings rely on low-quality evidence from a small number of studies.

Key findings

• Postoperative C5 palsy incidence was lower with preventive foraminotomy than with laminoplasty alone (OR=0.32; P =0.02).
• Japanese Orthopedic Association score recovery rate was higher in the foraminotomy group (P =0.002).
• Operation time was shorter with laminoplasty alone (P <0.001); other outcomes were comparable between groups.

Why it matters

C5 palsy is a postoperative outcome that preventive foraminotomy is intended to reduce. The pooled findings suggest a lower incidence and better score recovery with the added procedure, while reported complication and radiologic outcomes were not significantly different. However, the evidence base is limited and vulnerable to bias, so the results do not establish a definitive benefit.

What to keep in mind

Only four studies, all retrospective and described as low-quality evidence, were included; the authors note that these studies are prone to bias.