PMID- 31607084
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2586-6583 (Print)
IS  - 2586-6591 (Electronic)
IS  - 2586-6591 (Linking)
VI  - 16
IP  - 3
DP  - 2019 Sep
TI  - The Clinical Implications and Complications of Anterior Versus Posterior Surgery 
      for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An 
      Updated Systematic Review and Meta-Analysis.
PG  - 530-541
LID - 10.14245/ns.1938326.163 [doi]
AB  - OBJECTIVE: Theoretically, the optimal approach is determined by the status of 
      ossification of the posterior longitudinal ligament (OPLL) and sagittal 
      alignment. However, there have long been disputes about the optimum surgical 
      approach of OPLL. This study is to compare risk-effectiveness between anterior 
      decompression and fusion (ADF) and laminoplasty and laminectomy with fusion 
      (LP/LF) for the patient with cervical myelopathy due to multilevel cervical OPLL. 
      METHODS: We searched core databases, and compared complication and outcomes 
      between ADF and LP/LF for patients with multiple OPLL for the cervical spine. The 
      incidence of complications such as neurologic deterioration, C5 palsy, and dura 
      tear was assessed. Changes in JOA score between baseline and final evaluations 
      were assessed for 2 groups. The minimal clinically important difference (MCID) 
      was utilized for evaluating clinical significance. We calculated Peto odds ratio 
      (POR) and mean difference for the incidence and continuous variables, 
      respectively. RESULTS: We included data from 21 articles involving 3,872 patients 
      with cervical myelopathy with OPLL. Major neurologic deficits such as paraplegia, 
      quadriplegia developed 2.17% in the ADF group and 1.11% in the LP/LF group, and 
      POR was 2.16. Mean difference of JOA score improvement of 2 groups was 1.30, and 
      the mean difference showed a statistical significance. However, 1.3 points of JOA 
      improvement cannot reach 2.5 points of the MCID. CONCLUSION: Anterior surgery 
      often led to rare but critical complications, and the difference of neurological 
      improvement between 2 groups was below a clinically meaningful level. Posterior 
      surgeries may be appropriate in the treatment of multilevel cervical myelopathy 
      with OPLL.
FAU - Kim, Dong Hwan
AU  - Kim DH
AD  - Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
FAU - Lee, Chang-Hyun
AU  - Lee CH
AD  - Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
FAU - Ko, Young San
AU  - Ko YS
AD  - Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
FAU - Yang, Seung Heon
AU  - Yang SH
AD  - Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
FAU - Kim, Chi Heon
AU  - Kim CH
AD  - Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
AD  - Department of Neurosurgery, Seoul National University College of Medicine, Seoul, 
      Korea.
FAU - Park, Sung Bae
AU  - Park SB
AD  - Department of Neurosurgery, Seoul Metropolitan Government - Seoul National 
      University Boramae Medical Center, Seoul, Korea.
FAU - Chung, Chun Kee
AU  - Chung CK
AD  - Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
AD  - Department of Neurosurgery, Seoul National University College of Medicine, Seoul, 
      Korea.
AD  - Department of Brain and Cognitive Sciences, Seoul National University College of 
      Natural Sciences, Seoul, Korea.
LA  - eng
GR  - 2017R1D1A3B03028470/National Research Foundation of Korea/
GR  - Ministry of Education/
PT  - Journal Article
DEP - 20190930
PL  - Korea (South)
TA  - Neurospine
JT  - Neurospine
JID - 101724936
PMC - PMC6790730
OTO - NOTNLM
OT  - Anterior decompression and fusion
OT  - Complication
OT  - Laminoplasty
OT  - Ossification of the posterior longitudinal ligament
OT  - Recovery rate
COIS- The authors have nothing to disclose.
EDAT- 2019/10/15 06:00
MHDA- 2019/10/15 06:01
PMCR- 2019/09/01
CRDT- 2019/10/15 06:00
PHST- 2019/05/09 00:00 [received]
PHST- 2019/08/28 00:00 [accepted]
PHST- 2019/10/15 06:00 [entrez]
PHST- 2019/10/15 06:00 [pubmed]
PHST- 2019/10/15 06:01 [medline]
PHST- 2019/09/01 00:00 [pmc-release]
AID - ns.1938326.163 [pii]
AID - ns-1938326-163 [pii]
AID - 10.14245/ns.1938326.163 [doi]
PST - ppublish
SO  - Neurospine. 2019 Sep;16(3):530-541. doi: 10.14245/ns.1938326.163. Epub 2019 Sep 
      30.