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

Abstract 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 ce...

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Main Authors: Ke Zhang, Zhencheng Xiong, Yuhao Zhang, Ziyi Zhuang, Sizhen Zhan, Mingsheng Tan, Ping Yi
Format: Article
Language:English
Published: BMC 2025-08-01
Series:BMC Surgery
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Online Access:https://doi.org/10.1186/s12893-025-03074-6
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author Ke Zhang
Zhencheng Xiong
Yuhao Zhang
Ziyi Zhuang
Sizhen Zhan
Mingsheng Tan
Ping Yi
author_facet Ke Zhang
Zhencheng Xiong
Yuhao Zhang
Ziyi Zhuang
Sizhen Zhan
Mingsheng Tan
Ping Yi
author_sort Ke Zhang
collection DOAJ
description Abstract 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 a summary of the key risk and protective factors identified in the included studies is provided 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), conventional 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 a larger preoperative C2–C7 Cobb angle 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.
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spelling doaj-art-b62fd5cc127248df8500bcfa372851252025-08-24T11:05:31ZengBMCBMC Surgery1471-24822025-08-0125111610.1186/s12893-025-03074-6Risk factors of axial symptoms after posterior cervical spine surgery: a meta-analysisKe Zhang0Zhencheng Xiong1Yuhao Zhang2Ziyi Zhuang3Sizhen Zhan4Mingsheng Tan5Ping Yi6Graduate School of Beijing, University of Chinese MedicineDepartment of Orthopedic Surgery, West China Medical School, West China Hospital, Sichuan UniversityGraduate School of Beijing, University of Chinese MedicineGraduate School of Beijing, University of Chinese MedicineDepartment of Spine Surgery, China-Japanese Friendship HospitalDepartment of Spine Surgery, China-Japanese Friendship HospitalDepartment of Spine Surgery, China-Japanese Friendship HospitalAbstract 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 a summary of the key risk and protective factors identified in the included studies is provided 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), conventional 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 a larger preoperative C2–C7 Cobb angle 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.https://doi.org/10.1186/s12893-025-03074-6Cervical spine surgeryAxial symptomsMeta-analysisRisk factors
spellingShingle Ke Zhang
Zhencheng Xiong
Yuhao Zhang
Ziyi Zhuang
Sizhen Zhan
Mingsheng Tan
Ping Yi
Risk factors of axial symptoms after posterior cervical spine surgery: a meta-analysis
BMC Surgery
Cervical spine surgery
Axial symptoms
Meta-analysis
Risk factors
title Risk factors of axial symptoms after posterior cervical spine surgery: a meta-analysis
title_full Risk factors of axial symptoms after posterior cervical spine surgery: a meta-analysis
title_fullStr Risk factors of axial symptoms after posterior cervical spine surgery: a meta-analysis
title_full_unstemmed Risk factors of axial symptoms after posterior cervical spine surgery: a meta-analysis
title_short Risk factors of axial symptoms after posterior cervical spine surgery: a meta-analysis
title_sort risk factors of axial symptoms after posterior cervical spine surgery a meta analysis
topic Cervical spine surgery
Axial symptoms
Meta-analysis
Risk factors
url https://doi.org/10.1186/s12893-025-03074-6
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