Neurospine.  2019 Sep;16(3):530-541. 10.14245/ns.1938326.163.

The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: an Updated Systematic Review and Meta-Analysis

• Kim DH
• Lee CH
• Ko YS
• Yang SH
• Kim CH
• Park SB
• Chung CK

• KMID: 2463572
• DOI: http://doi.org/10.14245/ns.1938326.163

Abstract

OBJECTIVE
Theoretically, the optimal approach is determined by the status of ossification of the posterior longitudinal ligament (OPLL) and sagittal alignment. However, there have long been disputes about the optimum surgical approach of OPLL. This study is to compare risk-effectiveness between anterior decompression and fusion (ADF) and laminoplasty and laminectomy with fusion (LP/LF) for the patient with cervical myelopathy due to multilevel cervical OPLL.
METHODS
We searched core databases, and compared complication and outcomes between ADF and LP/LF for patients with multiple OPLL for the cervical spine. The incidence of complications such as neurologic deterioration, C5 palsy, and dura tear was assessed. Changes in JOA score between baseline and final evaluations were assessed for 2 groups. The minimal clinically important difference (MCID) was utilized for evaluating clinical significance. We calculated Peto odds ratio (POR) and mean difference for the incidence and continuous variables, respectively.
RESULTS
We included data from 21 articles involving 3,872 patients with cervical myelopathy with OPLL. Major neurologic deficits such as paraplegia, quadriplegia developed 2.17% in the ADF group and 1.11% in the LP/LF group, and POR was 2.16. Mean difference of JOA score improvement of 2 groups was 1.30, and the mean difference showed a statistical significance. However, 1.3 points of JOA improvement cannot reach 2.5 points of the MCID.
CONCLUSION
Anterior surgery often led to rare but critical complications, and the difference of neurological improvement between 2 groups was below a clinically meaningful level. Posterior surgeries may be appropriate in the treatment of multilevel cervical myelopathy with OPLL.

Keyword

Anterior decompression and fusion; Laminoplasty; Ossification of the posterior longitudinal ligament; Recovery rate; Complication

MeSH Terms

Decompression
Dissent and Disputes
Humans
Incidence
Laminectomy
Laminoplasty
Longitudinal Ligaments*
Neurologic Manifestations
Odds Ratio
Paralysis
Paraplegia
Quadriplegia
Spinal Cord Diseases
Spine
Tears