Anterior corpectomy comparing to posterior decompression surgery for the treatment of multi-level ossification of posterior longitudinal ligament: A meta-analysis

Background: Posterior decompression surgery consisting of laminoplasty is generally considered be the treatment of choice for upper thoracic OPLL. Here, we describe a patient who, 10 years following a C3–T4 level laminectomy, developed recurrent OPLL at the T2–3 level with kyphosis requiring a posterior fusion. Case Description: A 64-year-old male with CT documented OPLL at the C3–4, C6–7, and T1–4 levels, originally underwent a cervicothoracic laminectomy with good results. However, 10 years later, when T2–3 OPLL recurred along with kyphosis, he warranted an additional posterior fusion. Conclusion: Due to the long-term risks of developing kyphotic deformity/instability, more patients undergoing initial decompressive surgery alone for upper thoracic OPLL should be considered for primary fusions.

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Pharmacotherapy for Ossification of the Spinal Ligaments: Clinical Trial of Disodium (1-Hydroxyethylidene) Diphosphonate to Inhibit Progression of Ossification of the Posterior Longitudinal Ligament in the Cervical Spine after Posterior Decompression Surgery

OPLL ◽

10.1007/978-4-431-32563-5_23 ◽

2007 ◽

pp. 169-176

Author(s):

Kazuo Yonenobu ◽

Kensei Nagata ◽

Kuniyoshi Abumi ◽

Yoshiaki Toyama ◽

Sinya Kawai

Keyword(s):

Clinical Trial ◽

Cervical Spine ◽

Posterior Longitudinal Ligament ◽

Decompression Surgery ◽

Posterior Decompression ◽

Spinal Ligaments

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Comparison of anterior corpectomy and fusion versus laminoplasty for the treatment of cervical ossification of posterior longitudinal ligament: a meta-analysis

Neurosurgical FOCUS ◽

10.3171/2016.3.focus15596 ◽

2016 ◽

Vol 40 (6) ◽

pp. E8 ◽

Cited By ~ 22

Author(s):

Zihao Chen ◽

Bin Liu ◽

Jianwen Dong ◽

Feng Feng ◽

Ruiqiang Chen ◽

...

Keyword(s):

Data Analysis ◽

Fixed Effects ◽

Data Extraction ◽

Meta Analysis ◽

Japanese Orthopaedic Association ◽

Operation Time ◽

Posterior Longitudinal Ligament ◽

Treatment Method ◽

Fixed Effects Model ◽

Anterior Corpectomy

OBJECTIVE The purpose of this study was to compare the effectiveness and safety of anterior corpectomy and fusion (ACF) with laminoplasty for the treatment of patients diagnosed with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS The authors searched electronic databases for relevant studies that compared the use of ACF with laminoplasty for the treatment of patients with OPLL. Data extraction and quality assessment were conducted, and statistical software was used for data analysis. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used. RESULTS A total of 10 nonrandomized controlled studies involving 819 patients were included. Postoperative Japanese Orthopaedic Association (JOA) score (p = 0.02, 95% CI 0.30–2.81) was better in the ACF group than in the laminoplasty group. The recovery rate was superior in the ACF group for patients with an occupying ratio of OPLL of ≥ 60% (p < 0.00001, 95% CI 21.27–34.44) and for patients with kyphotic alignment (p < 0.00001, 95% CI 16.49–27.17). Data analysis also showed that the ACF group was associated with a higher incidence of complications (p = 0.02, 95% CI 1.08–2.59) and reoperations (p = 0.002, 95% CI 1.83–14.79), longer operation time (p = 0.01, 95% CI 17.72 –160.75), and more blood loss (p = 0.0004, 95% CI 42.22–148.45). CONCLUSIONS For patients with an occupying ratio ≥ 60% or with kyphotic cervical alignment, ACF appears to be the preferable treatment method. Nevertheless, laminoplasty seems to be effective and safe enough for patients with an occupying ratio < 60% or with adequate cervical lordosis. However, it must be emphasized that a surgical strategy should be made based on the individual patient. Further randomized controlled trials comparing the use of ACF with laminoplasty for the treatment of OPLL should be performed to make a more convincing conclusion.

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

Neurosurgical FOCUS ◽

10.3171/2016.3.focus1630 ◽

2016 ◽

Vol 40 (6) ◽

pp. E9 ◽

Cited By ~ 12

Author(s):

Syed K. Mehdi ◽

Vincent J. Alentado ◽

Bryan S. Lee ◽

Thomas E. Mroz ◽

Edward C. Benzel ◽

...

Keyword(s):

Lower Incidence ◽

Meta Analysis ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Japanese Orthopaedic Association Score ◽

Posterior Decompression ◽

Mean Values ◽

Analysis Group ◽

Significant Difference ◽

Poor Outcomes

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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