Toshitaka Yoshii1, Satoru Egawa2, Takashi Hirai2, Takashi Kaito3, Kanji Mori4, Masao Koda5, Hirotaka Chikuda6, Tomohiko Hasegawa7, Shiro Imagama8, Masahiro Yoshida9, Motoki Iwasaki10, Atsushi Okawa11, Yoshiharu Kawaguchi12. 1. Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. Electronic address: yoshii.orth@tmd.ac.jp. 2. Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo 113-8511, Japan. 3. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. 4. Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2112, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. 5. Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. 6. Department of Orthopedic Surgery, Gunma University School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8513, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. 7. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3125, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. 8. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi 466-8550, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. 9. Department of Surgery, International University of Health and Welfare Ichikawa Hospital, Konodai 6-1-14, Ichikawashi, Chiba 272-0827, Japan. 10. Department of Orthopedic Surgery, Osaka Rosai Hospital, Nagasonecho 1179-3, Sakaishi, Kitaku, Osaka 591-8025, Japan. 11. Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan. 12. Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0114, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan.
Abstract
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.
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.