Risk factors of axial symptoms after posterior cervical spine surgery：a meta-analysis

Background Axial symptoms are a frequent complication after posterior cervical spine surgery.While literature has documented risk factors for these symptoms, they are still debated. This study's objective was to explore the risk elements associated with axial symptoms following posterior cervical spine surgery. Methods Our search encompassed The Cochrane Library, PubMed, Embase, and web of science databases, focusing on studies documenting complications related to cervical laminectomy and laminoplasty. In every study included, we documented axial symptom occurrences and computed Odds ratios (ORs), 95% confidence intervals (Cls), Q values, and 12 values. Results Nineteen different studies were finally included,and the final risk factors were analysed in summary as described below:preoperative neck pain(OR=2.22,95%CI(1.48,3.33),P=0.0001),facet joint destruction(OR=2.32,95%CI(1.59,3.39),P<0.0001),C2involvement(OR=3.78,95%CI(2.04,7.01),P<0.0001),C7spinous process(muscle)destruction(OR=3.38,95%CI(1.13,10.08),P=0.03),routine posterior cervical spine surgery(OR=6.18,95%CI(2.43,15.69),P=0.0001);protective factors were as follows:Increase range of motion after cervical spine surgery(OR=0.64,95%CI(0.44,0.92),P=0.02),enlargement of the preoperative C2-7 Cobb angle(OR=0.57,95%CI(0.39,0.82),P=0.003). Conclusion Preoperative neck pain, facet joints destruction, C7 spinous process(muscle)destruction, conventional posterior cervical spine surgery and C2 involvement were risk factors for postoperative axial symptoms after posterior cervical spine surgery, and preoperative C2-C7 Cobb enlargement and increased postoperative cervical range of motion were protective factors for postoperative axial symptoms, however, gender, age, operation time, JOA score, C2-7 SVA, blood loss, and types of disease were not associated with postoperative axial symptoms. Considering the scarce volume of research available, this inference demands careful interpretation and necessitates expanded studies.