Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I<jats:sup>2</jats:sup> values. Forest plots were constructed for each analysis group.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p &lt; 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p &lt; 0.0001), and a lower incidence of OPLL progression (&lt; 1% vs 6.3%; p &lt; 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior decompression alone in patients with OPLL. These results indicate that surgical decompression and fusion lead to a faster recovery, improved postoperative neurological functioning, and a lower incidence of OPLL progression compared with posterior decompression only. Furthermore, decompression and fusion did not lead to a greater incidence of complications compared with posterior decompression only.</jats:p></jats:sec>

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

“…[ 4 ] The posterior procedures, including laminoplasty (LP) and laminectomy with fusion (LF), are recognized as reliable and effective way in treating multilevel cervical OPLL. [ 5 , 6 ] However, there is no clear conclusion on which method, LP or LF, is better. [ 7 ] Therefore, we performed a meta-analysis to assess the effectiveness and safety of the 2 surgical procedures for multilevel cervical OPLL.…”

Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery

“…The disease onset typically affect patients in their fifties, and has an incidence twice as high for males than for females (Epstein, 1992 ; Choi et al, 2011 ; Kommu et al, 2014 ). Surgical decompression of the spinal cord is usually necessary when the medullar compression leads to symptomatic neurological deterioration (Mehdi et al, 2016 ); nonetheless, despite appropriate decompression residual motor impairment is found in some patients. The degree of canal stenosis, intramedullary conditions, initial motor score and patient age have been related with the outcome where the prognosis is less optimistic for older patients with severe neurologic deficit and marked myelopathy signs (Gu et al, 2015 ; Kwon et al, 2015 ).…”

Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament

“…During preoperative planning, we must keep in mind the risk that cervical laminoplasty is associated not only with a high probability of OPLL progression but also with the development of postoperative kyphosis. 2,8,12,18,21 Therefore, even for the K-line plus cases before cervical laminoplasty, postoperative OPLL progression and/or kyphotic changes can possibly lead to later neurological deterioration. In addition, the dynamic aspects of the cervical spine (i.e., segmental instability due to posterior decompression surgery) might be important for the development of late neurological deterioration after cervical laminoplasty.…”

“…An alternative to cervical laminoplasty, fusion at the initial surgery should be recommended for many cases of cervical OPLL to prevent future revision surgery, given that fusion eliminates kyphosis progression and is associated with a lower incidence of OPLL progression compared with decompression alone. 14,15,18 Chen et al retrospectively investigated 75 patients with multilevel OPLL. 1 Twenty-two of these patients underwent ACDF, 28 underwent posterior cervical decompression and fusion (PCDF), and 25 underwent laminoplasty.…”