Comparison of anterior corpectomy and fusion versus laminoplasty for the treatment of cervical ossification of posterior longitudinal ligament: a meta-analysis

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The purpose of this study was to compare the effectiveness and safety of anterior corpectomy and fusion (ACF) with laminoplasty for the treatment of patients diagnosed with cervical ossification of the posterior longitudinal ligament (OPLL).</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors searched electronic databases for relevant studies that compared the use of ACF with laminoplasty for the treatment of patients with OPLL. Data extraction and quality assessment were conducted, and statistical software was used for data analysis. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 10 nonrandomized controlled studies involving 819 patients were included. Postoperative Japanese Orthopaedic Association (JOA) score (p = 0.02, 95% CI 0.30–2.81) was better in the ACF group than in the laminoplasty group. The recovery rate was superior in the ACF group for patients with an occupying ratio of OPLL of ≥ 60% (p &lt; 0.00001, 95% CI 21.27–34.44) and for patients with kyphotic alignment (p &lt; 0.00001, 95% CI 16.49–27.17). Data analysis also showed that the ACF group was associated with a higher incidence of complications (p = 0.02, 95% CI 1.08–2.59) and reoperations (p = 0.002, 95% CI 1.83–14.79), longer operation time (p = 0.01, 95% CI 17.72 –160.75), and more blood loss (p = 0.0004, 95% CI 42.22–148.45).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>For patients with an occupying ratio ≥ 60% or with kyphotic cervical alignment, ACF appears to be the preferable treatment method. Nevertheless, laminoplasty seems to be effective and safe enough for patients with an occupying ratio &lt; 60% or with adequate cervical lordosis. However, it must be emphasized that a surgical strategy should be made based on the individual patient. Further randomized controlled trials comparing the use of ACF with laminoplasty for the treatment of OPLL should be performed to make a more convincing conclusion.</jats:p></jats:sec>

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

“…19 Almost all papers concluded that ADF achieves better neurological improvement compared with laminoplasty in the treatment of cervical myelopathy due to OPLL. [19][20][21][22][23][24] In accordance with previous systematic reviews and meta-analyses, we found significant superiority of anterior surgery in terms of neurological improvement after the surgery. However, they emphasized 538 www.e-neurospine.org that the difference in neurological improvement was statistically significant, and overlooked the fact that there was no clinical significance.…”

“…There are several meta-analyses dealt with anterior versus posterior surgery for OPLL. [18][19][20][21][22][23][24]37,[42][43][44] Although all the reported meta-analyses included 8-13 papers, we found 21 relevant papers. We tried to find out why other studies did not include the studies we included, but we could not find it.…”

“…16,17 Several meta-analyses were comparing anterior versus posterior surgery for cervical myelopathy with OPLL. [18][19][20][21][22][23][24] They focused only on the recovery of neurological status at the final follow-up, and underestimate clinical implication of the effect size of the recovery and critical complications of the surgeries. Information regarding the surgical risks of these treatment options is critically important for surgical decision making because severe morbidity such as tetraplegia, paraplegia, and death can occur.…”

Curcumin Increase the Expression of Neural Stem/Progenitor Cells and Improves Functional Recovery after Spinal Cord Injury

“…According to previous studies, neural stem/progenitor cells (NSPCs) exist in the human adult stage as well as fetal stage 11 , 15) . Moreover, recent studies reported that SCI could induce expression of NSPCs, and resulting NSPCs were related to functional and histologic recoveries after SCI 8 , 14 , 25 , 29) . Stem cell therapy for SCI is focused on clinical usage of NSPCs’ biological activity.…”

Cervical corpectomy for sub-axial retro-vertebral body lesions

“…Bone grafting maintains the vertebral height and provides adequate vertebral orientation and stability. Plating prevents graft dislodgment and increases the rate of bony fusion [4][5][6][7][8][9].…”