Evaluation of early complications following cervical laminectomy and posterior fixation: a cross-sectional study

Background Cervical laminectomy and posterior fixation are commonly performed procedures in patients with multilevel cervical spinal stenosis. Despite their efficacy, these interventions are associated with early postoperative complications such as C5 nerve root palsy, dural tears, and surgical site infections (SSIs). This study aimed to evaluate the frequency and characteristics of these complications in an Iranian cohort. Methods This cross-sectional study included 180 adult patients with moderate-to-severe cervical myelopathy who underwent multilevel posterior cervical decompression and instrumentation at Al-Zahra and Kashani hospitals during 2022. Inclusion criteria were based on clinical and MRI findings. Patients with prior cervical surgery or active infection were excluded. All surgeries were performed using a standardized technique. Vancomycin powder (1 g) was applied intraoperatively. Patients were followed for at least 3 months to monitor early complications. Results Of the 180 patients, 104 (57.7%) were males and 76 (42.3%) were females, with a mean age of 54.6 years. Hypertension (53%) was the most common comorbidity. Postoperative C5 palsy occurred in 7.7% of patients, with most recovering within 1 month and all within 3 months. Surgical site infection was observed in 5.6% of cases despite the use of vancomycin powder. Accidental dural tears and vertebral artery injuries occurred in 9.4% and 1.6% of patients, respectively. Conclusion C5 palsy remains a frequent complication despite prophylactic bilateral foraminotomy, particularly in patients with OPLL. Topical vancomycin powder may reduce SSIs but does not eliminate infection risk. Careful patient selection, optimized technique, and potential use of intraoperative neuromonitoring may enhance outcomes in posterior cervical surgery.