A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical ossification of the posterior longitudinal ligament.

BACKGROUND: The optimal surgical procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial because there are few comprehensive studies investigating the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and compare the surgical outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP), which are representative procedures for cervical OPLL.

METHODS: An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMP for cervical OPLL. The language was restricted to English, and the year of publication was from January 1980 to December 2018. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) score, cervical alignment, surgical complications and reoperation rate. Then, meta-analysis was performed for these surgical outcomes.

RESULTS: Twelve studies were obtained, including 1 prospective cohort study and 11 retrospective cohort studies. In the meta-analysis, neurological recovery rate in JOA score was greater in ADF than in LAMP, especially in patients with a large canal occupying ratio (≥60%) and preoperative kyphotic alignment. ADF also exhibited more favorable results in postoperative cervical alignment. In contrast, operating time and intraoperative blood loss were greater in ADF. Surgical complications were more frequently seen in ADF, leading to higher rates of reoperation.

CONCLUSIONS: This systematic review and meta-analysis showed both the merits and shortcomings of ADF and LAMP. ADF resulted in more favorable neurological recovery compared to LAMP, especially for patients with massive OPLL and kyphotic alignment. Postoperative cervical lordosis was also better preserved in ADF. However, ADF was associated with greater surgical invasion and higher incidences of surgical complications.