Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis
- 544 Downloads
The purpose of this research is to compare the clinical efficacy, postoperative complication and surgical trauma between anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of the posterior longitudinal ligament (OPLL).
Systematic review and meta-analysis.
An comprehensive search of literature was implemented in three electronic databases (Embase, Pubmed, and the Cochrane library). Randomized or non-randomized controlled studies published since January 1990 to July 2017 that compared anterior cervical corpectomy and fusion (ACCF) versus posterior laminoplasty (LAMP) for the treatment of cervical oppressive myelopathy owing to OPLL were acquired. Exclusion criteria were non-human studies, non-controlled studies, combined anterior and posterior operative approach, the other anterior or posterior approaches involving cervical discectomy and fusion and laminectomy with (or without) instrumented fusion, revision surgeries, and cervical myelopathy caused by cervical spondylotic myelopathy. The quality of the included articles was evaluated according to GRADE. The main outcome measures included: preoperative and postoperative Japanese Orthopedic Association (JOA) score; neuro-functional recovery rate; complication rate; reoperation rate; preoperative and postoperative C2–C7 Cobb angle; operation time and intraoperative blood loss; and subgroup analysis was performed according to the mean preoperative canal occupying ratio (Subgroup A:the mean preoperative canal occupying ratio < 60%, and Subgroup B:the mean preoperative canal occupying ratio ≥ 60%).
A total of 10 studies containing 735 patients were included in this meta-analysis. And all of the selected studies were non-randomized controlled trials with relatively low quality as assessed by GRADE. The results revealed that there was no obvious statistical difference in preoperative JOA score between the ACCF and LAMP groups in both subgroups. Also, in subgroup A (the mean preoperative canal occupying ratio < 60%), no obvious statistical difference was observed in the postoperative JOA score and neurofunctional recovery rate between the ACCF and LAMP groups. But, in subgroup B (the mean preoperative canal occupying ratio ≥ 60%), the ACCF group illustrated obviously higher postoperative JOA score and neurofunctional recovery rate than the LAMP group (P < 0.01, WMD 1.89 [1.50, 2.28] and P < 0.01, WMD 24.40 [20.10, 28.70], respectively). Moreover, the incidence of both complication and reoperation was markedly higher in the ACCF group compared with LAMP group (P < 0.05, OR 1.76 [1.05, 2.97] and P < 0.05, OR 4.63 [1.86, 11.52], respectively). In addition, the preoperative cervical C2–C7 Cobb angle was obviously larger in the LAMP group compared with ACCF group (P < 0.05, WMD − 5.77 [− 9.70, − 1.84]). But no statistically obvious difference was detected in the postoperative cervical C2–C7 Cobb angle between the two groups. Furthermore, the ACCF group showed significantly more operation time as well as blood loss compared with LAMP group (P < 0.01, WMD 111.43 [40.32,182.54], and P < 0.01, WMD 111.32 [61.22, 161.42], respectively).
In summary, when the preoperative canal occupying ratio < 60%, no palpable difference was tested in postoperative JOA score and neurofunctional recovery rate. But, when the preoperative canal occupying ratio ≥ 60% ACCF was associated with better postoperative JOA score and the recovery rate of neurological function compared with LAMP. Synchronously, ACCF in the cure for cervical myelopathy owing to OPLL led to more surgical trauma and more incidence of complication and reoperation. On the other hand, LAMP had gone a diminished postoperative C2–C7 Cobb angle, that might be a cause of relatively higher incidence of postoperative late neurofunctional deterioration. In brief, when the preoperative canal occupying ratio < 60%, LAMP seems to be effective and safe. However, when the preoperative canal occupying ratio ≥ 60%, we prefer to choose ACCF while complications could be controlled by careful manipulation and advanced surgical techniques. No matter which option you choose, benefits and risks ought to be balanced.
KeywordsCervical myelopathy Ossification of the posterior longitudinal ligament Anterior cervical corpectomy and fusion Laminoplasty Meta-analysis
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 4.Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, Yoshikawa H, Iwasaki M, Okuda S, Miyauchi A et al (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 2: advantages of anterior decompression and fusion over laminoplasty. Spine 32:654–660CrossRefPubMedGoogle Scholar
- 7.Ogawa Y, Chiba KM, Nakamura M, Takaishi H, Hirabayashi H, Hirabayashi K, Nishiwaki Y, Toyama Y (2005) Long-term results after expansive open-door laminoplasty for the segmental-type of ossification of the posterior longitudinal ligament of the cervical spine: a comparison with nonsegmental-type lesions. J Neurosurg Spine 3:198CrossRefPubMedGoogle Scholar
- 8.Sakai K, Okawa A, Takahashi M, Arai Y, Kawabata S, Enomoto M, Kato T, Hirai T, Shinomiya K (2012) Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine 37:367–376CrossRefPubMedGoogle Scholar
- 19.Masaki Y, Yamazaki M, Okawa A, Aramomi M, Hashimoto M, Koda M, Mochizuki M, Moriya H (2007) An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech 20:7–13CrossRefPubMedGoogle Scholar
- 33.Nishida N, Kanchiku T, Kato Y, Imajo Y, Yoshida Y, Kawano S, Taguchi T (2014) Biomechanical analysis of cervical myelopathy due to ossification of the posterior longitudinal ligament: effects of posterior decompression and kyphosis following decompression. Exp Ther Med 7:1095–1099CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Liu X, Chen Y, Yang H, Li T, Xu B, Chen D (2017) Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis. Eur Spine J 26:1–8Google Scholar
- 37.Tanno M, Furukawa KI, Ueyama K, Harata S, Motomura S (2003) Uniaxial cyclic stretch induces osteogenic differentiation and synthesis of bone morphogenetic proteins of spinal ligament cells derived from patients with ossification of the posterior longitudinal ligaments. Bone 33(4):475–484CrossRefPubMedGoogle Scholar
- 38.Katsumi K, Izumi T, Ito T, Hirano T, Watanabe K, Ohashi M (2016) Posterior instrumented fusion suppresses the progression of ossification of the posterior longitudinal ligament: a comparison of laminoplasty with and without instrumented fusion by three-dimensional analysis. Eur Spine J 25(5):1634CrossRefPubMedGoogle Scholar
- 39.Fargen KM, Cox JB, Hoh DJ (2012) Does ossification of the posterior longitudinal ligament progress after laminoplasty? radiographic and clinical evidence of ossification of the posterior longitudinal ligament lesion growth and the risk factors for late neurologic deterioration. J Neurosurg Spine 17(6):512CrossRefPubMedGoogle Scholar