Outcomes following Laminoplasty or Laminectomy and Fusion in Patients with Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament: A Systematic Review

Abstract

Study Design Systematic review. Objective To compare laminoplasty versus laminectomy and fusion in patients with cervical myelopathy caused by OPLL. Methods A systematic review was conducted using PubMed/Medline, Cochrane database, and Google scholar of articles. Only comparative studies in humans were included. Studies involving cervical trauma/fracture, infection, and tumor were excluded. Results Of 157 citations initially analyzed, 4 studies ultimately met our inclusion criteria: one class of evidence (CoE) II prospective cohort study and three CoE III retrospective cohort studies. The prospective cohort study found no significant difference between laminoplasty and laminectomy and fusion in the recovery rate from myelopathy. One CoE III retrospective cohort study reported a significantly higher recovery rate following laminoplasty. Another CoE III retrospective cohort study reported a significantly higher recovery rate in the laminectomy and fusion group. One CoE II prospective cohort study and one CoE III retrospective cohort study found no significant difference in pain improvement between patients treated with laminoplasty versus patients treated with laminectomy and fusion. All four studies reported a higher incidence of C5 palsy following laminectomy and fusion than laminoplasty. One CoE II prospective cohort and one CoE III retrospective cohort reported that there was no significant difference in axial neck pain between the two procedures. One CoE III retrospective cohort study suggested that there was no significant difference between groups in OPLL progression. Conclusion Data from four comparative studies was not sufficient to support the superiority of laminoplasty or laminectomy and fusion in treating cervical myelopathy caused by OPLL.

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

“…In particular, the rates of intraoperative dural leaks and postoperative C5 palsy have both been reported to be higher in patients with OPLL compared to other DCM pathologies [21,71]. These complications may be specific to certain approaches, however, with rates of DT being higher with anterior approaches and C5 palsy being higher with LF posterior approaches [30,31,33,37]. Several techniques specific to OPLL surgeries have been developed to combat the incidence of these complications including the ADF and the ACAF procedures [24,41].…”

“…It is characterized by less aggressive tissue disruption than that associated with LF, and can be performed using one of several different techniques [32]. The lack of instrumented fusion and laminectomy make the LAMP procedures better for preserving cervical ROM [33].…”

“…According to Wang et al [71], the incidence of C5 palsy is higher in patients with OPLL undergoing LAMP (5.5%) or anterior cervical decompression and fusion (8.1%) compared to patients with other forms of DCM (4.7%, 3.1%, respectively). Furthermore, Singhatanadgige et al [33] found that when only considering patients with OPLL, the incidence of C5 palsy was higher following LF (9.6%–25%) compared to LAMP (0%–8%).…”

Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament

“…[ 1 ] Surgical treatment is need because it usually lead to progressive and stepwise deterioration of neurologic function. [ 2 ] Surgical treatment with either anterior or posterior approaches can result in satisfactory clinical results. [ 3 ] When ≥3 segments are involved, the complication rates associated with anterior surgery accelerate.…”

Surgical interventions for cervical spondylosis due to ossification of posterior longitudinal ligament

“…However, OPLL is different from other etiological factors of myelopathy with respect to neck ROM that may incite further progression of OPLL. [ 67 ] In general, laminoplasty results in long-term decrease in ROM due to unintended autofusion along the lateral margins of the laminoplasty. [ 4 ] It is suggested that progression of OPLL is stimulated by the dynamic factors and ROM stabilization may reduce the progression of OPLL.…”