Revisiting the Incidence and Risk Factors for Cervical Postlaminectomy Kyphosis

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.