Efficacy of Preventive Foraminotomy in Laminoplasty for Reducing Postoperative C5 Palsy

Study Design: Systematic review and meta-analysis study. Objective: This study aimed to evaluate the effect of preventive foraminotomy during laminoplasty on the outcomes of patients with postoperative C5 palsy. Summary of Background Data: Preventive foraminotomy at the C4–C5 level has been proposed as a strategy to reduce postoperative C5 palsy; however, its effectiveness remains controversial. In addition, no meta-analysis on this topic has been published to date. Methods: PubMed, Embase, Cochrane Library, and SCOPUS databases were systematically searched for relevant articles published up to July 3, 2025, that compared 2 surgical techniques: laminoplasty with preventive foraminotomy (F group) and laminoplasty alone (NF group). A total of 491 articles were searched, and 4 studies (n=603) met all the inclusion criteria. Results: The incidence of postoperative C5 palsy, the primary endpoint of the current meta-analysis, was significantly lower in the F group than in the NF group (OR=0.32; P =0.02). Regarding the clinical parameter, the Japanese Orthopedic Association score recovery rate was higher in the F group than in the NF group ( P =0.002). The radiologic and complication rates, including hinge fractures, dural tears, infections, and the degree of posterior cord shifting, were not significantly different between the groups. The operation time was shorter in the NF group than in the F group ( P <0.001); however, the other outcomes were comparable between the groups. Conclusions: Though preventive foraminotomy in laminoplasty showed less C5 palsy, these findings were based on low-quality evidence from a small number of retrospective studies that are prone to bias.