Anterior Corpectomy Comparing to Posterior Decompression Surgery for the Treatment of Multi-level Ossification of Posterior Longitudinal Ligament: A Meta-analysis

Background: Ossification of posterior longitudinal ligament (OPLL) can be treated by two surgical strategies, anterior decompression with fusion and posterior decompression with laminoplasty or laminectomy. It has been debated which surgical approach is more appropriate for the treatment of multilevel OPLL. The purpose of this study is to compare the outcomes of anterior corpectomy surgery to posterior decompression surgery for the treatment of multilevel ossification of OPLL.

Materials And Methods: The databases of Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials was searched and we included trials which comparing anterior to posterior surgery for multilevel OPLL. There was no language restrictions. Two authors independently assessed the methodological quality of included trials. The data of outcomes was extracted and analyzed by STATA 12.0.

Results: Six studies were included in this meta-analysis, and totally 123 patients were undergone anterior cervical corpectomy and fusion (ACCF) and 216 patients were decompressed by posterior approach. In this meta-analysis, the postoperative JOA score of anterior surgery was higher than posterior surgery at one year follow-up. Consistently, the recovery rate of anterior surgery was higher than posterior surgery. However, the anterior surgery (ACCF) showed significantly more complications comparing to posterior surgery for the treatment of multilevel OPLL.

Conclusion: This meta-analysis indicates that the parameters of outcomes and functional recovery of patients performed with anterior surgery achieve better JOA scores and recovery rates to those with posterior surgery. Though the incidence of complications of anterior surgery are higher than posterior surgery, the anterior directly decompression is advised when the complications could be controlled by advanced surgical technique.