The effectiveness of prophylactic foraminotomy in preventing C5 palsy paralysis: a meta- analysis

Background: With the development of medical science, surgical treatment of cervical spondylosis has increasingly achieved positive results. However, postoperative complications have also gradually increased, cervical 5 (C5) nerve root paralysis syndrome is one of the more serious complications. Different theories have been formulated regarding what causes this after posterior cervical surgery and studies have been conducted to test these theories, but no consensus has been reached. Methods: : We systematically searched the literature for studies on the clinical effect of foraminotomy on C5 nerve root palsy; our search included the MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase and Allied Health Literature (CINAHL) databases from their establishment to present. Results: : A total of 6 studies meeting the inclusion criteria and including 1174 patients were included in this meta-analysis: Prophylactic foraminotomy was performed in 498 patients and foraminoplasty was performed in 676 patients. There was no significant difference in the incidence of C5 palsy or the Japanese Orthopedic Association（JOA）scores between prophylactic foraminotomy and ordinary cervical spine surgery [OR = 0.67, 95% Cl (0.15,3.10), P = 0.61], [SMD = 0.15, 95% Cl(−0.06,0.36), P = 0.15]. However, the duration of prophylactic foraminotomy was longer than that of conventional cervical surgery [MD = 27.38, 95% Cl (21.73,33.02), P < 0.00001]. Conclusions: : Meta-analysis results showed that prophylactic foraminotomy was not significant in preventing the incidence of C5 nerve palsy and JOA score , but prolonged the operation time Therefore, we do not recommend prophylactic foraminotomy to prevent postoperative C5 nerve root palsy in light of the current evidence.