Complications Following Cervical Laminoplasty With Reconstruction: A Systematic Review and Meta-Analysis.

Abstract

Systematic review and meta-analysis. To synthesize pooled complication rates after cervical laminoplasty with reconstruction and to evaluate differences by surgical indication. Cervical laminoplasty with reconstruction is a widely and increasingly used posterior decompression technique for degenerative cervical myelopathy (DCM) and ossification of the posterior longitudinal ligament (OPLL). Despite effectiveness, postoperative complications remain a concern, and a focused quantitative synthesis of complication incidence is lacking. PubMed, Embase, and Scopus were searched from inception to March 2026 for clinical studies reporting postoperative complications after cervical laminoplasty with reconstruction. Random-effects meta-analysis of proportions using Freeman-Tukey double arcsine transformation was performed for each complication category. Subgroup analysis compared DCM and OPLL cohorts, and meta-regression assessed the association between follow-up duration and complication incidence. Sensitivity analyses included leave-one-out analysis, exclusion of large registry studies, and restriction to studies with minimum 12-month follow-up. Sixty-eight studies (n=6732 patients) met inclusion criteria. Pooled complication incidences were: C5 palsy 4.07% (95% CI: 3.08-5.17%), axial neck pain 13.74% (9.14-19.02%), reoperation 2.72% (1.38-4.39%), dural/CSF complications 1.48% (0.60-2.62%), wound infection 1.89% (1.16-2.75%), hematoma 0.25% (0.00-0.89%), airway issues/dysphagia 0.68% (0.16-1.45%), and progressive kyphosis 0.80% (0.03-2.11%). C5 palsy was significantly higher in OPLL (5.86%) than DCM (3.34%) cohorts ( P =0.021). Meta-regression revealed no significant association between follow-up duration and complication incidence for any category. Substantial heterogeneity ( I ²: 34.9-91.3%) reflected variability in complication definitions and reporting practices across studies. This meta-analysis provides pooled incidence estimates for complications after cervical laminoplasty with reconstruction. C5 palsy is the most reliably reported complication and occurs more frequently in OPLL populations. Axial neck pain is the most common complication but is limited by highly variable definitions. Standardized complication definitions and consistent reporting are needed to improve future comparisons. Level III: systematic review of observational studies.