Postoperative complications across different cervical spine surgical procedures: a systematic review and meta-analysis [version 1; peer review: awaiting peer review]

Background Surgical procedures on the cervical spine are frequently performed to treat spinal diseases such as degenerative disc degeneration, trauma, tumors, and infections. However, postoperative complications are a cause for concern, and the surgical procedure with the lowest complication risk still unknown. Methods A comprehensive literature search was carried out in different databases from the beginning of the study to January 2024. Observational studies that reported the incidence of postoperative complications following anterior cervical discectomy and fusion (ACDF), posterior cervical foraminotomy (PCF), laminoplasty, laminectomy with fusion, and corpectomy were included in the review. Outcomes like reoperation rates, infections, and nerve injuries were analyzed using random-effects models, with ORs (ORs) and 95% confidence intervals (CIs). Results 13 studies with 22,874 patients were included. ACDF was associated with higher complication rates versus PCF (OR 1.84, 95% CI 1.31 to 2.60) and laminoplasty (OR 2.85, 95% CI 1.84 to 4.41). Laminectomy with fusion showed greater pseudarthrosis (OR 2.57, 95% CI 1.35 to 4.90) and reoperation rates (OR 2.46, 95% CI 1.36 to 4.43) than ACDF. No differences were detected between other procedures. Conclusion Complications risk significantly differs based on surgical strategy and technique, with ACDF potentially having higher rates compared to less invasive methods.