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Anterior or posterior decompression is recommended for cervical myelopathy. The C5 nerve root palsy is one of the common complications from these procedures. However, the risk of C5 nerve root palsy associated with these procedures is still moot. Therefore, the risk of C5 palsy comparing anterior (anterior discectomy and fusion (ACDF), and anterior corpectomy and fusion (ACCF)) and posterior procedures (laminoplasty and laminectomy) in cervical myelopathy patients was systematically reviewed and meta-analyzed. We thoroughly searched MedLine and Scopus database without restricted date of the publication until 2021. Any studies those met inclusion and exclusion criteria were included to the present meta-analysis. Data from each study were collected. Odds ratio with 95% confident interval was calculated from each study and pooled data. The result was showed in Forest plot. Funnel plot was drawn to evaluate potential publication bias. The results of 1,039 studies showed that 16 studies were met inclusion and exclusion criteria. The outcomes showed that ACDF group had the lowest risk of C5 nerve root palsy (pooled odds ratio =0.27, 95%CI=0.13-0.55 when compared with ACCF), followed by ACCF and laminoplasty groups which had the same risks (pooled odds ratio = 0.34, 95%CI= 0.24-0.50), Laminectomy group had the highest risk of C5 nerve root palsy (Laminoplasty compared with Laminectomy, pooled odds ratio = 0.35, 95%CI = 0.14 – 0.90 and ACCF compared with Laminectomy, pooled odds ratio = 0.37, 95%CI = 0.21 – 0.66). Funnel plot showed no publication bias. The results of this study provide useful information in choosing the appropriate treatment for each patient's pathology.
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Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 Palsy after Decompression Surgery for Cervical Myelopathy: Review of the Literature. Spine (Phila Pa 1976). 2003; 28(21): 2447–51.
Hashimoto M, Mochizuki M, Aiba A, Okawa A, Hayashi K, Sakuma T, et al. C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases. Eur Spine J. 2010; 19(10): 1702–10.
Nassr A, Eck JC, Ponnappan RK, Zanoun RR, Donaldson WF, Kang JD. The incidence of C5 palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976). 2012; 37(3): 174–8.
Katsumi K, Yamazaki A, Watanabe K, Ohashi M, Shoji H. Analysis of C5 Palsy After Cervical Open-door Laminoplasty. J Spinal Disord Tech. 2013; 26(4): 177–82.
Imagama S, Matsuyama Y, Yukawa Y, Kawakami N, Kamiya M, Kanemura T, et al. C5 palsy after cervical laminoplasty: A multicentre study. J Bone Jt Surg - Ser B. 2010; 92(3): 393–400.
GRADE handbook [Internet]. [cited 2021 Aug 26]. Available from: https://gdt.gradepro.org/app/handbook/handbook.html
Chapter 10: Analysing data and undertaking meta-analyses | Cochrane Training [Internet]. [cited 2021 Oct 1]. Available from: https://training.cochrane.org/handbook/current/chapter-10
Bydon M, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Gokaslan ZL, et al. Incidence and prognostic factors of C5 Palsy:
A clinical study of 1001 cases and review of the literature. Neurosurgery. 2014; 74(6): 595–604.
Chang PY, Chan RC, Tsai YA, Huang WC, Cheng H, Wang JC, et al. Quantitative measures of functional outcomes and quality of life in patients with C5 palsy. J Chinese Med Assoc [Internet]. 2013; 76(7): 378–84. Available from: http://dx.doi.org/10.1016/j.jcma.2013.03.008
Chen Y, Liu X, Chen D, Wang X, Yuan W. Surgical strategy for ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics. 2012; 35(8): 1231–7.
Highsmith JM, Dhall SS, Haid RW, Rodts GE, Mummaneni P V. Treatment of cervical stenotic myelopathy: A cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion - Clinical article. J Neurosurg Spine. 2011; 14(5): 619–25.
Kim B, Yoon DH, Shin HC, Kim KN, Yi S, Shin DA, et al. Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament. Spine J [Internet]. 2015; 15(5): 875–84. Available from: http://dx.doi.org/10.1016/j.spinee.2015.01.028
Kim S, Lee SH, Kim ES, Eoh W. Clinical and radiographic analysis of C5 palsy after anterior cervical decompression and fusion for cervical degenerative disease. J Spinal Disord Tech. 2014; 27(8): 436–41.
Lin Q, Zhou X, Wang X, Cao P, Tsai N, Yuan W. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J. 2012; 21(3): 474–81.
Liu Y, Qi M, Chen H, Yang L, Wang X, Shi G, et al. Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J. 2012; 21(12): 2428–35.
Lubelski D, Derakhshan A, Nowacki AS, Wang JC, Steinmetz MP, Benzel EC, et al. Predicting C5 palsy via the use of preoperative anatomic measurements. Spine J [Internet]. 2014; 14(9): 1895–901. Available from: http://dx.doi.org/10.1016/j.spinee.2013.10.038
Qian L, Shao J, Liu Z, Cheng L, Zeng Z, Jia Y, et al. Comparison of the safety and efficacy of anterior “skip” corpectomy versus posterior decompression in the treatment of cervical spondylotic myelopathy. J Orthop Surg Res. 2014; 9(1): 1–6.
Sakaura H, Hosono N, Mukai Y, Ishii T, Iwasaki M, Yoshikawa H. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: A comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976). 2005; 30(7): 756–9.
Shibuya S, Komatsubara S, Oka S, Kanda Y, Arima N, Yamamoto T. Differences between subtotal corpectomy and laminoplasty for cervical spondylotic myelopathy. Spinal Cord [Internet]. 2010; 48(3): 214–20. Available from: http://dx.doi.org/10.1038/sc.2009.114
Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: A long-term follow-up study over 10 years. Spine (Phila Pa 1976). 2001; 26(13): 1443–7.
Xia G, Tian R, Xu T, Li H, Zhang X. Spinal posterior movement after posterior cervical decompression surgery: Clinical findings and factors affecting postoperative functional recovery. Orthopedics. 2011; 34(12): 911–8.