Skip to main content
SpringerLink
Log in

Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis

  • Review
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Revision surgery for OPLL is undesirable for both patients and physicians. However, the risk factors for reoperation are not clear. Thus, we sought to review the existing literature and determine the factors associated with higher reoperation rates in patients with OPLL. A search was performed using Pubmed, Embase, Web of Sciences, and Ovid to include studies regarding the risk factors of reoperation for OPLL. RoBANS (Risk of Bias Assessment tool for Nonrandomized Studies) was used for risk of bias analysis. Heterogeneity of studies and publication bias was assessed, and sensitivity analysis was performed. Statistical analysis was performed with a p-value < 0.05 using SPSS software (version 23). Twenty studies with 129 reoperated and 2,793 non-reoperated patients were included. The pooled reoperation rate was 5% (95% CI: 4% to 7). The most common cause of reoperation was residual OPLL or OPLL progression (n = 51, 39.53%). An increased risk of additional surgery was found with pre-operative cervical or thoracic angle (Standardized mean difference = −0.44; 95% CI: -0.69 to -0.19; p = 0.0061), post-operative CSF leak (Odds ratio, OR = 4.97; 95% CI: 2.48 to 9.96; p = 0.0005), and graft and/or hardware failure (OR = 192.09; 95% CI: 6.68 to 5521.69; p = 0.0101). Apart from the factors identified in our study, the association of other variables with the risk of second surgery could not be ruled out, owing to the complexity of the relationship and significant bias in the current literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Not applicable.

References

  1. Hirai T, Yoshii T, Ushio S et al (2020) Clinical characteristics in patients with ossification of the posterior longitudinal ligament: A prospective multi-institutional cross-sectional study. Sci Rep 10(1):5532. https://doi.org/10.1038/s41598-020-62278-3

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Kawaguchi Y, Matsumoto M, Iwasaki M et al (2014) New classification system for ossification of the posterior longitudinal ligament using CT images. J Orthop Sci Off J Jpn Orthop Assoc 19(4):530–536. https://doi.org/10.1007/s00776-014-0577-4

    Article  Google Scholar 

  3. Head J, Rymarczuk G, Stricsek G et al (2019) Ossification of the Posterior Longitudinal Ligament: surgical approaches and associated complications. Neurospine 16(3):517–529. https://doi.org/10.14245/ns.1938222.111

    Article  PubMed  PubMed Central  Google Scholar 

  4. Li H, Dai LY (2011) A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament. Spine J Off J North Am Spine Soc 11(11):1049–1057. https://doi.org/10.1016/j.spinee.2011.09.008

    Article  Google Scholar 

  5. Wu D, Zhao Liu C, Yang H, Li H, Chen N (2017) Surgical interventions for cervical spondylosis due to ossification of posterior longitudinal ligament. Medicine (Baltimore) 96(33):e7590. https://doi.org/10.1097/MD.0000000000007590

    Article  PubMed  Google Scholar 

  6. Kawaguchi Y, Kanamori M, Ishihara H et al (2001) Progression of ossification of the posterior longitudinal ligament following en bloc cervical laminoplasty. J Bone Joint Surg Am 83(12):1798–1802. https://doi.org/10.2106/00004623-200112000-00005

    Article  PubMed  CAS  Google Scholar 

  7. Sakai K, Okawa A, Takahashi M et al (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(5):367–376. https://doi.org/10.1097/BRS.0b013e31821f4a51

    Article  PubMed  Google Scholar 

  8. Tian W, Weng C, Liu B et al (2013) Intraoperative 3-dimensional navigation and ultrasonography during posterior decompression with instrumented fusion for ossification of the posterior longitudinal ligament in the thoracic spine. J Spinal Disord Tech 26(6):E227–E234. https://doi.org/10.1097/BSD.0b013e318286ba39

    Article  PubMed  Google Scholar 

  9. Kim SY, Park JE, Lee YJ et al (2013) Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 66(4):408–414. https://doi.org/10.1016/j.jclinepi.2012.09.016

    Article  PubMed  Google Scholar 

  10. Olkin I, Dahabreh IJ, Trikalinos TA (2012) GOSH - a graphical display of study heterogeneity. Res Synth Methods 3(3):214–223. https://doi.org/10.1002/jrsm.1053

    Article  PubMed  Google Scholar 

  11. Ido K, Shimizu K, Nakayama Y et al (1995) Anterior decompression and fusion for ossification of Posterior Longitudinal Ligament in the thoracic spine. J Spinal Disord 8(4):317–323. https://doi.org/10.1097/00002517-199508040-00010

    Article  PubMed  CAS  Google Scholar 

  12. Epstein NE (2000) The value of anterior cervical plating in preventing vertebral fracture and graft extrusion after multilevel anterior cervical corpectomy with posterior wiring and fusion: Indications, results, and complications. J Spinal Disord 13(1):9–15. https://doi.org/10.1097/00002517-200002000-00002

    Article  PubMed  CAS  Google Scholar 

  13. Tani T, Ushida T, Ishida K, Iai H, Noguchi T, Yamamoto H (2002) Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine 27(22):2491–2498. https://doi.org/10.1097/00007632-200211150-00013

    Article  PubMed  Google Scholar 

  14. Iwasaki M, Kawaguchi Y, Kimura T, Yonenobu K (2002) Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg Spine 96(2):180–189. https://doi.org/10.3171/spi.2002.96.2.0180

    Article  Google Scholar 

  15. Lee SH, Ahn Y, Lee JH (2008) Laser-assisted anterior cervical corpectomy versus posterior laminoplasty for cervical myelopathic patients with multilevel ossification of the Posterior Longitudinal Ligament. Photomed Laser Surg 26(2):119–127. https://doi.org/10.1089/pho.2007.2110

    Article  PubMed  Google Scholar 

  16. Takahata M, Ito M, Abumi K, Kotani Y, Sudo H, Minami A (2008) Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of Posterior Longitudinal Ligament. Spine 33(11):1199–1208. https://doi.org/10.1097/BRS.0b013e3181714515

    Article  PubMed  Google Scholar 

  17. Kawahara N, Tomita K, Murakami H et al (2008) Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine 33(1):39–46. https://doi.org/10.1097/BRS.0b013e31815e3911

    Article  PubMed  Google Scholar 

  18. Chen Y, Guo Y, Lu X et al (2011) Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech 24(1):24–30. https://doi.org/10.1097/BSD.0b013e3181c7e91e

    Article  PubMed  CAS  Google Scholar 

  19. Kawaguchi Y, Nakano M, Yasuda T, Seki S, Hori T, Kimura T (2014) Anterior decompressive surgery after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament. Spine J Off J North Am Spine Soc 14(6):955–963. https://doi.org/10.1016/j.spinee.2013.07.457

    Article  Google Scholar 

  20. Chen Y, Yang L, Liu Y, Yang H, Wang X, Chen D (2014) Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the Posterior Longitudinal Ligament. PLoS One 9(7):e102008. https://doi.org/10.1371/journal.pone.0102008

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Fujimori T, Iwasaki M, Okuda S et al (2014) Long-term results of cervical myelopathy due to ossification of the posterior longitudinal ligament with an occupying ratio of 60% or more. Spine 39(1):58–67. https://doi.org/10.1097/BRS.0000000000000054

    Article  PubMed  Google Scholar 

  22. Kim B, Yoon DH, Shin HC et al (2015) Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament. Spine J Off J North Am Spine Soc 15(5):875–884. https://doi.org/10.1016/j.spinee.2015.01.028

    Article  Google Scholar 

  23. 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 Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 26(4):1173–1180. https://doi.org/10.1007/s00586-016-4912-7

    Article  Google Scholar 

  24. Ha Y, Moon BJ, You NK et al (2016) Clinical characteristics and surgical outcome of revision surgery in patients with cervical ossification of the Posterior Longitudinal Ligament. World Neurosurg 90:164–171. https://doi.org/10.1016/j.wneu.2016.02.054

    Article  PubMed  Google Scholar 

  25. Imagama S, Ando K, Ito Z et al (2017) Risk factors for ineffectiveness of posterior decompression and dekyphotic corrective fusion with instrumentation for beak-type thoracic ossification of the Posterior Longitudinal Ligament: A single institute study. Neurosurgery 80(5):800–808. https://doi.org/10.1093/neuros/nyw130

    Article  PubMed  Google Scholar 

  26. Kawaguchi Y, Nakano M, Yasuda T et al (2019) Clinical impact of ossification of the Posterior Longitudinal Ligament progression after cervical laminoplasty. Clin Spine Surg 32(3):E133–E139. https://doi.org/10.1097/BSD.0000000000000747

    Article  PubMed  Google Scholar 

  27. Nakashima H, Kanemura T, Satake K et al (2020) Reoperation for late neurological deterioration after laminoplasty in individuals with degenerative cervical myelopathy: Comparison of cases of cervical spondylosis and ossification of the Posterior Longitudinal Ligament. Spine 45(15):E909–E916. https://doi.org/10.1097/BRS.0000000000003408

    Article  PubMed  Google Scholar 

  28. Lee BJ, Lee S, Jeon SR, Roh SW, Park JH (2021) A new indicator predicting the degree of cord shift after posterior decompression of cervical ossification of the posterior longitudinal ligament extended to the c2 level and its clinical usefulness. Turk Neurosurg 31(6):866–872. https://doi.org/10.5137/1019-5149.JTN.31668-20.1

    Article  PubMed  Google Scholar 

  29. Lee NJ, Boddapati V, Mathew J et al (2023) What is the impact of surgical approach in the treatment of degenerative cervical myelopathy in patients With OPLL? A propensity-score matched, multi-center analysis on inpatient and post-discharge 90-day outcomes. Glob Spine J 13(2):324–333. https://doi.org/10.1177/2192568221994797

    Article  Google Scholar 

  30. Inoue T, Maki S, Yoshii T et al (2022) Is anterior decompression and fusion more beneficial than laminoplasty for K-line (+) cervical ossification of the posterior longitudinal ligament? An analysis using propensity score matching. J Neurosurg Spine 37(1):13–20. https://doi.org/10.3171/2021.11.SPINE211205

    Article  Google Scholar 

  31. Yamazaki A, Homma T, Uchiyama S, Katsumi Y, Okumura H (1999) Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine 24(1):32–34. https://doi.org/10.1097/00007632-199901010-00008

    Article  PubMed  CAS  Google Scholar 

  32. Lee CK, Shin DA, Yi S et al (2016) Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament. J Neurosurg Spine 24(1):100–107. https://doi.org/10.3171/2015.4.SPINE141004

    Article  PubMed  Google Scholar 

  33. Villavicencio AT, Babuska JM, Ashton A et al (2011) Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery 68(5):1309–1316. https://doi.org/10.1227/NEU.0b013e31820b51f3

    Article  PubMed  Google Scholar 

  34. Gum JL, Glassman SD, Douglas LR, Carreon LY (2012) Correlation between cervical spine sagittal alignment and clinical outcome after anterior cervical discectomy and fusion. Am J Orthop Belle Mead NJ 41(6):E81-84

    PubMed  Google Scholar 

  35. Abiola R, Rubery P, Mesfin A (2016) Ossification of the Posterior Longitudinal Ligament: Etiology, diagnosis, and outcomes of nonoperative and operative management. Glob Spine J 6(2):195–204. https://doi.org/10.1055/s-0035-1556580

    Article  Google Scholar 

  36. Nakashima H, Tetreault L, Nagoshi N et al (2016) Comparison of outcomes of surgical treatment for ossification of the Posterior Longitudinal Ligament versus other forms of degenerative cervical myelopathy: Results from the prospective, multicenter AOSpine CSM-International study of 479 patients. J Bone Joint Surg Am 98(5):370–378. https://doi.org/10.2106/JBJS.O.00397

    Article  PubMed  Google Scholar 

  37. Mizuno J, Nakagawa H, Matsuo N, Song J (2005) Dural ossification associated with cervical ossification of the posterior longitudinal ligament: frequency of dural ossification and comparison of neuroimaging modalities in ability to identify the disease. J Neurosurg Spine 2(4):425–430. https://doi.org/10.3171/spi.2005.2.4.0425

    Article  PubMed  Google Scholar 

  38. Yoshii T, Hirai T, Yamada T et al (2017) Intraoperative evaluation using mobile computed tomography in anterior cervical decompression with floating method for massive ossification of the posterior longitudinal ligament. J Orthop Surg 12(1):12. https://doi.org/10.1186/s13018-017-0515-1

    Article  Google Scholar 

  39. Moon JH, Lee S, Chung CK, Kim CH, Heo W (2017) How to address cerebrospinal fluid leakage following ossification of the posterior longitudinal ligament surgery. J Clin Neurosci 45:172–179. https://doi.org/10.1016/j.jocn.2017.05.028

    Article  PubMed  Google Scholar 

  40. Yee TJ, Swong K, Park P (2020) Complications of anterior cervical spine surgery: a systematic review of the literature. J Spine Surg 6(1):302–322. https://doi.org/10.21037/jss.2020.01.14

    Article  PubMed  PubMed Central  Google Scholar 

  41. Longo M, De la Garza RR, Gelfand Y, Echt M, Kinon MD, Yassari R (2019) Incidence and predictors of hardware failure after instrumentation for spine metastasis: A single-institutional series. World Neurosurg 125:e1170–e1175. https://doi.org/10.1016/j.wneu.2019.01.272

    Article  PubMed  Google Scholar 

  42. Sastry RA, Yu J, Niu T et al (2021) Hardware failure and reoperation after hybrid anterior cervical corpectomy and discectomy for multilevel spondylotic disease: A retrospective single-institution cohort study. Interdiscip Neurosurg 25:101234. https://doi.org/10.1016/j.inat.2021.101234

    Article  Google Scholar 

  43. Shapiro SA, Snyder W (1997) Spinal instrumentation with a low complication rate. Surg Neurol 48(6):566–574. https://doi.org/10.1016/s0090-3019(97)00296-6

    Article  PubMed  CAS  Google Scholar 

  44. Hashimoto K, Aizawa T, Ozawa H et al (2019) Reoperation rates after laminoplasty for cervical disorders: A 26-year period survival function method analysis. Spine Surg Relat Res 3(4):304–311. https://doi.org/10.22603/ssrr.2019-0028

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gu Y, Cao P, Gao R et al (2014) Incidence and risk factors of C5 palsy following posterior cervical decompression: a systematic review. PLoS ONE 9(8):e101933. https://doi.org/10.1371/journal.pone.0101933

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. Oshima Y, Takeshita K, Kato S et al (2022) Comparison between the Japanese Orthopaedic Association (JOA) Score and Patient-Reported JOA (PRO-JOA) score to evaluate surgical outcomes of degenerative cervical myelopathy. Glob Spine J 12(5):795–800. https://doi.org/10.1177/2192568220964167

    Article  Google Scholar 

  47. Zhang J, Liang Q, Qin D et al (2021) The anterior versus posterior approach for the treatment of ossification of the posterior longitudinal ligament in the cervical spine: A systematic review and meta-analysis. J Spinal Cord Med 44(3):340–349. https://doi.org/10.1080/10790268.2019.1692179

    Article  PubMed  CAS  Google Scholar 

  48. Liu H, Li Y, Chen Y, Wu W, Zou D (2013) Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22(7):1480–1488. https://doi.org/10.1007/s00586-013-2707-7

    Article  Google Scholar 

  49. Bajamal AH, Kim SH, Arifianto MR et al (2019) Posterior surgical techniques for cervical spondylotic myelopathy: WFNS Spine Committee recommendations. Neurospine 16(3):421–434. https://doi.org/10.14245/ns.1938274.137

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. University College of Medical Sciences and G.T.B. Hospital, Delhi, India

    Anish Tayal & Bhavya Pahwa

  2. Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India

    Kanwaljeet Garg

Authors
  1. Anish Tayal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bhavya Pahwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kanwaljeet Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Idea for the article (Anish Tayal), literature search (Anish Tayal, Bhavya Pahwa and Kanwaljeet Garg), data analysis (Kanwaljeet Garg), drafted manuscript (Anish Tayal and Bhavya Pahwa) and critically revised the work (Kanwaljeet Garg).

Corresponding author

Correspondence to Kanwaljeet Garg.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The study did not require ethics approval because no patient data was involved.

Conflict of interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

10143_2023_2215_MOESM1_ESM.jpg

SI 1 Forest plot of demographics and clinical variables with the occurrence of reoperation among patients with ossification of the posterior longitudinal ligament. a Age. b Funnel plot of the age of patients in various studies. c Gender. d Diabetes mellitus. e Duration of symptoms. f Preoperative Japanese Orthopedic Association score (JPG 208 KB)

10143_2023_2215_MOESM2_ESM.jpg

SI 2 Forest plot of radiological variables with the occurrence of reoperation among patients with ossification of the posterior longitudinal ligament. a Type of ossification of the posterior longitudinal ligament. b Number of ossified segments of posterior longitudinal ligament. c Occupancy ratio (JPG 127 KB)

10143_2023_2215_MOESM3_ESM.jpg

SI 3 Forest plot of surgical and outcome parameters with the occurrence of reoperation among patients with ossification of the posterior longitudinal ligament. a Anterior surgical approach. b Posterior surgical approach. c fusion vs. decompression only. d Postoperative Japanese Orthopedic Association score. e Recovery rate. f Postoperative cervical or thoracic angle (JPG 219 KB)

10143_2023_2215_MOESM4_ESM.jpg

SI 4 Forest plot of other complications with the occurrence of reoperation among patients with ossification of the posterior longitudinal ligament. a Axial pain. b Hematoma. c Neurological deterioration and/or C5 palsy. d Pseudoarthrosis. e Recurrent laryngeal nerve palsy and/or dysphagia and/or esophageal injury. f Surgical site infection (JPG 232 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tayal, A., Pahwa, B. & Garg, K. Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis. Neurosurg Rev 46, 313 (2023). https://doi.org/10.1007/s10143-023-02215-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10143-023-02215-w

Keywords

Search

Navigation