Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament

Lee, Chang‐Hyun; Jahng, Tae-Ahn; Hyun, Seung-Jae; Kim, Ki-Jeong; Kim, Hyun-Jib

doi:10.1097/bsd.0000000000000058

Cited by 95 publications

(75 citation statements)

References 11 publications

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“…The authors found a decreased rate of progression in the PDF population compared with laminectomy and/or laminoplasty populations (p < 0.05). 29 Our findings support this hypothesis. We found the incidence of OPLL progression to be statistically significantly lower in the decompression and fusion population compared with the decompression-only population (p < 0.0001).…”

supporting

confidence: 83%

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

Mehdi

Alentado

Lee

et al. 2016

FOC

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OBJECTIVE 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. METHODS 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 I2 values. Forest plots were constructed for each analysis group. RESULTS 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 < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS 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.

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supporting

confidence: 83%

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

Mehdi

Alentado

Lee

et al. 2016

FOC

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“…This different result in the subgroup analysis was caused by the relative weighting of the studies in the overall versus the long-term follow-up analysis. In the overall analysis, the studies of Zhang et al 19 and Lee et al 10 had very low weights (less than 2% for each), whereas in the long-term follow-up analysis they were weighted almost equally with the study of Yang et al 18 (approximately 30% each). The reason for this difference was that the study by Woods et al, 17 which had a very narrow standard deviation, was excluded in the long-term follow-up analysis.…”

Section: Discussionmentioning

confidence: 99%

“…A paper "in press" was included. 10 Two reviewers independently assessed the eligibility of all studies retrieved from the databases. Any disagreement between the reviewers was resolved through discussion.…”

Section: Methods Information Sourcesmentioning

confidence: 99%

“…When necessary, we contacted corresponding authors of the eligible studies to obtain additional data or clarification. 10,17 We assessed the bias risk using the Cochrane Collaboration's "risk of bias" tool in a randomized controlled study and a modified form of the Newcastle-Ottawa Scale for nonran- domized studies. 6,16 At least 2 researchers independently assessed the risk of bias, with disagreements resolved through discussion.…”

Section: Methods Information Sourcesmentioning

confidence: 99%

“…Finally, a total of 7 studies were included in the meta-analysis (6 English papers and 1 Chinese paper). 2,7,10,11,[17][18][19] The detailed selection process is shown in Fig. 1.…”

mentioning

confidence: 99%

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Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Lee

Kang

et al. 2015

SPI

Self Cite

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OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI −0.37 to 0.54, p = 0.07) and neck pain VAS score (MD −0.33, 95% CI −1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results.

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Cervical Laminoplasty

Blecher¹,

Yılmaz²

2019

The Resident's Guide to Spine Surgery

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Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament

Cited by 95 publications

References 11 publications

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

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

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Cervical Laminoplasty

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