The Impact of Cervical Laminoplasty and Cervical Foraminotomy on Axial Neck Pain: A Systematic Review and Meta-Analysis

Study Design: Systematic Review and Meta-Analysis. Objectives: We analyzed patient-reported outcomes (PROs) focused on axial neck pain following cervical laminoplasty (CL) and foraminotomy (CF) for symptomatic cervical spondylosis to determine whether motion-preserving procedures targeting compressive radiculopathy/myelopathy also provide relief of axial neck pain and to investigate risk factors for persistent postoperative axial neck pain. Methods: The PubMed and Cochrane Library databases were systematically searched for articles published from 2014 to 2023 describing pain-related outcomes following CL and CF. Data regarding PROs, reoperation rates, and risk factors for postoperative axial neck pain were also collected. Results: Thirty studies met inclusion criteria for analysis. There were 2499 cases (2129 CL and 370 CF) with mean ages of 63.2 and 59.3 years for CL and CF, respectively. CL patients had improved mean postoperative visual analogue scale and neck disability index (NDI) scores compared to preoperative values, with mean differences of -1.97 (CI -2.52, -1.42; P < 0.0001) and -12.27 (CI -15.01, -9.54; P < 0.0001), respectively. CF patients had improved mean postoperative NDI scores compared to preoperative values, with mean difference of -15.15 (CI -23.79, -6.50; P = 0.0064). Presence of anterolisthesis, loss of cervical muscle volume, diabetes, age, and regional malalignment are independent predictors of postoperative axial neck pain. Conclusions: Motion-sparing cervical decompressive surgery performed for compressive radiculopathy or myelopathy can also provide significant relief of axial neck pain, suggesting that preoperative axial neck pain is not an absolute contraindication to non-fusion decompressive surgery for degenerative cervical pathologies.