Comparison of the surgeries for the ossification of the posterior longitudinal ligament-related cervical spondylosis

Abstract

Objective: We designed and performed a network meta-analysis to compare the clinical outcomes among the 5 surgeries—anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), laminoplasty (LP), laminectomy (LC), and posterior decompression with instrumented fusion (PDF)—for patients with cervical spondylosis related to the ossification of the posterior longitudinal ligament (OPLL). Methods: Databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019) were selected for literature search. We performed a network meta-analysis with the included studies. A Newcastle-Ottawa scale was employed to assess the study quality of the included studies. Results: Total 23 studies with 1516 patients were included in our analysis. We found that ACCF achieved the most improvement in the Japanese Orthopaedic Association Scores and excellent and good recovery rate, ACAF achieved the best improvement of the improvement rate and lordosis. LP got the best operative time and blood loss. Conclusions: Our results suggested that both anterior (ACCF and ACAF) and posterior (LP, LC, and PDF) procedures have their strengths and weaknesses. Clinicians need to select the most appropriate surgery with a comprehensive consideration of the clinical condition of each patient with OPLL-related cervical spondylosis.

Anterior Decompression and Fusion for the Treatment of Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament: A Narrative Review

“…Because OPLL most commonly affects the cervical spine, many surgical strategies for treating OPLL-induced cervical myelopathy have been proposed [3,11,12]. Anterior decompression and fusion (ADF) techniques include anterior cervical discectomy and fusion (ACDF) and Asian Spine J.…”

Biomechanical Comparison of Anterior Cervical Corpectomy Decompression and Fusion, Anterior Cervical Discectomy and Fusion, and Anterior Controllable Antedisplacement and Fusion in the Surgical Treatment of Multilevel Cervical Spondylotic Myelopathy: A Finite Element Analysis

“…The reconstructed anterior column of ACAF and ACDF is consist of three interbody cages and C4 and C5 vertebral bodies, which increased the graft–endplate interface and decreased load sharing, while that of ACCF was only a titanium mesh. In addition, cage subsidence has not been reported in clinical studies with short‐term follow‐up on the ACAF technique 12–16 . This suggests that ACAF might yield superior outcomes in preventing cage subsidence.…”

“…In addition, cage subsidence has not been reported in clinical studies with short-term follow-up on the ACAF technique. [12][13][14][15][16] This suggests that ACAF might yield superior outcomes in preventing cage subsidence. However, the findings of this study also revealed that in extension and lateral bending, ACAF exhibited higher maximum stress at the caudal endplate compared to ACDF, suggesting that the risk of subsidence of the internal body in ACAF still existed.…”

Comparison of the outcome after anterior cervical ossified posterior longitudinal ligament en bloc resection versus posterior total laminectomy and fusion in patients with ossification of the cervical posterior longitudinal ligament: a prospective randomized controlled trial

“…The patients were reviewed at three, six, 12, and 24 months postoperatively. The Japanese Orthopaedic Association (JOA) 10 scores were used to assess neurological status, and the rate of recovery was recorded as final JOA score – preoperative JOA score/17 – preoperative JOA score × 100%. In order to further study the indications for ACOE, the patients were divided into subgroups according to the COR and K-line, respectively.…”

“…An incidence of 8% has been reported, 9 and 13.3% when there is dural ossification. 10 An anterior floating method can be used in an attempt to avoid these risks by separating the layer of ossification ventrally accompanying the expansion of the dural sac; this can achieve decompression of the spinal cord while maintaining the integrity of the dura. However, using this method may lead to recurrent compression postoperatively due to incomplete decompression.…”