Anterior Cervical Controllable Antedisplacement and Fusion (ACAF) Versus Anterior Cervical Corpectomy and Fusion (ACCF) for Ossification of the Cervical Posterior Longitudinal Ligament (OPLL) in Chinese Population: a Systematic Review And...

Overview

Journal Neurosurg Rev

Specialty Neurosurgery

Date 2024 Oct 11

PMID 39392503

Authors

Meng Wang

Gaigai Yang

Beijun Zhou

Zhengmei Cao

Yixuan Li

Jiayi Tan

Zifan Long

Zhihong Xiao

Mingjiang Luo

Affiliations

Soon will be listed here.

Abstract

This study aimed to systematically review and compare the efficacy and safety of anterior cervical controllable antedisplacement and fusion (ACAF) versus anterior cervical corpectomy and fusion (ACCF) in treating ossification of the cervical posterior longitudinal ligament (OPLL), focusing on surgery-related indicators and postoperative outcomes. This review was conducted and reported in accordance with the Cochrane Handbook for Systematic Reviews of Interventions guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards. The methodological quality of this systematic review was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. A detailed search strategy was implemented to retrieve literature from electronic databases, including PubMed, EMBASE, and the Cochrane Library, followed by quality assessment and data extraction for eligible studies. A total of 5 studies involving 366 participants were included. ACAF was associated with significantly fewer complications (OR = 0.25, 95% CI [0.12, 0.51], p = 0.000), including a lower incidence of cerebrospinal fluid (CSF) leakage (OR = 0.20, 95% CI [0.08, 0.52], p = 0.000). ACAF also showed better outcomes in postoperative neck disability index (NDI) scores (SMD = -0.48, 95% CI [-0.81, -0.15], p = 0.020), C2-C7 angle (SMD = 1.29, 95% CI [0.56, 2.03], p = 0.000), spinal canal area (SCA) (SMD = 0.93, 95% CI [0.56, 1.29], p = 0.000), and diameter of the spinal cord (DSC) (SMD = 0.38, 95% CI [0.11, 0.66], p = 0.010). Additionally, ACAF improved The Japanese Orthopedic Association (JOA) scores (SMD = 0.29, 95% CI [0.01, 0.57], p = 0.040) but required longer operation time (SMD = 1.08, 95% CI [0.01, 2.15], p = 0.049). No significant differences were found in blood loss (SMD = 0.23, 95% CI [-0.34, 0.79], p = 0.431), hospital stay (SMD = 0.65, 95% CI [-1.46, 2.76], p = 0.547), and improvement rate (IR) (SMD = 0.38, 95% CI [-0.10, 0.86], p = 0.118). The current meta-analysis indicated that ACAF surgery can effectively reduce the incidence of complications, significantly increase the spinal canal area and improve the spatial conditions of the spinal cord compared to those associated with ACCF surgery. This is more advantageous for the postoperative neurological recovery of patients. Nonetheless, it is crucial to approach these findings with a degree of caution.

Citing Articles

Anterior Controllable Antedisplacement and Fusion (ACAF) for Cervical Stenosis Patients With Hyperextension Injury: A Retrospective Study.

Sun S, Miao Y, Xu T, Sun K, Lu Y, Sun J Orthop Surg. 2024; 17(2):500-512.

PMID: 39667811 PMC: 11787972. DOI: 10.1111/os.14319.

References

Sun J, Sun K, Wang Y, Shi J, Yang H, Guo Y . Quantitative Anterior Enlargement of the Spinal Canal by Anterior Controllable Antedisplacement and Fusion for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament with Myelopathy. World Neurosurg. 2018; 120:e1098-e1106. DOI: 10.1016/j.wneu.2018.08.233. View

Kalb S, Martirosyan N, Perez-Orribo L, Kalani M, Theodore N . Analysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament. Neurosurg Focus. 2011; 30(3):E11. DOI: 10.3171/2010.12.FOCUS10265. View

Bernstein D, Prong M, Kurucan E, Jain A, Menga E, Riew K . National Trends and Complications in the Surgical Management of Ossification of the Posterior Longitudinal Ligament (OPLL). Spine (Phila Pa 1976). 2019; 44(22):1550-1557. DOI: 10.1097/BRS.0000000000003127. View

Sun J, Shi J, Xu X, Yang Y, Wang Y, Kong Q . Anterior controllable antidisplacement and fusion surgery for the treatment of multilevel severe ossification of the posterior longitudinal ligament with myelopathy: preliminary clinical results of a novel technique. Eur Spine J. 2017; 27(6):1469-1478. DOI: 10.1007/s00586-017-5437-4. View

Boody B, Lendner M, Vaccaro A . Ossification of the posterior longitudinal ligament in the cervical spine: a review. Int Orthop. 2018; 43(4):797-805. DOI: 10.1007/s00264-018-4106-5. View

Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J . Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech. 2010; 24(1):24-30. DOI: 10.1097/BSD.0b013e3181c7e91e. View

Yan C, Jia H, Tan H, Yu X, Li M, Zhou X . How much space of the spinal canal should be restored by hoisting the vertebrae-OPLL complex for sufficient decompression in anterior controllable antedisplacement and fusion? A multicenter clinical radiological study. Spine J. 2020; 21(2):273-283. DOI: 10.1016/j.spinee.2020.09.008. View

Pitzen T, Chrobok J, Stulik J, Ruffing S, Drumm J, Sova L . Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multi-centric, randomized, controlled study. Spine (Phila Pa 1976). 2009; 34(7):641-6. DOI: 10.1097/BRS.0b013e318198ce10. View

Yang H, Sun J, Shi J, Guo Y, Zheng B, Wang Y . Anterior controllable antedisplacement fusion as a choice for 28 patients of cervical ossification of the posterior longitudinal ligament with dura ossification: the risk of cerebrospinal fluid leakage compared with anterior cervical corpectomy and.... Eur Spine J. 2018; 28(2):370-379. DOI: 10.1007/s00586-018-5813-8. View

10.

Sun K, Wang S, Huan L, Sun J, Xu X, Sun X . Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy. Eur Spine J. 2019; 29(5):1001-1012. DOI: 10.1007/s00586-019-06216-6. View

11.

Zhang B, Sun J, Xu X, Shi J, Guo Y, Sun K . Skip corpectomy and fusion (SCF) versus anterior controllable antedisplacement and fusion (ACAF): which is better for patients with multilevel cervical OPLL?. Arch Orthop Trauma Surg. 2019; 139(11):1533-1541. DOI: 10.1007/s00402-019-03182-y. View

12.

Kong Q, Sun X, Wang Y, Sun J, Sun P, Lv H . Risk assessment of vertebral artery injury in anterior controllable antedisplacement and fusion (ACAF) surgery: a cadaveric and radiologic study. Eur Spine J. 2019; 28(10):2417-2424. DOI: 10.1007/s00586-019-06111-0. View

13.

Li H, Zhang Q, Xing S, Min J, Shi J, Chen X . A novel revision surgery for treatment of cervical ossification of the posterior longitudinal ligament after initial posterior surgery: preliminary clinical investigation of anterior controllable antidisplacement and fusion. J Orthop Surg Res. 2018; 13(1):215. PMC: 6114058. DOI: 10.1186/s13018-018-0920-0. View

14.

Yan C, Zhao T, Ji C, Shi G, Guo Y, Sun J . Anterior controllable antedisplacement and fusion: quantitative analysis of a single surgeon's learning experience. Spine J. 2022; 22(6):941-950. DOI: 10.1016/j.spinee.2022.01.009. View

15.

Yongjun T, Yaming X, Biao C, Yonghong Y, Xinhua Z . Delayed Hemorrhage Followed by Vertebral Artery Injury during Cervical Anterior Controllable Antedisplacement and Fusion Surgery: Case Report and Literature Review. Orthop Surg. 2022; 14(10):2788-2795. PMC: 9531085. DOI: 10.1111/os.13413. View

16.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

17.

Shea B, Reeves B, Wells G, Thuku M, Hamel C, Moran J . AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358:j4008. PMC: 5833365. DOI: 10.1136/bmj.j4008. View

18.

Zeng X, Zhang Y, Kwong J, Zhang C, Li S, Sun F . The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015; 8(1):2-10. DOI: 10.1111/jebm.12141. View

19.

Luo M, Cao Q, Wang D, Tan R, Shi Y, Chen J . The impact of diabetes on postoperative outcomes following spine surgery: A meta-analysis of 40 cohort studies with 2.9 million participants. Int J Surg. 2022; 104:106789. DOI: 10.1016/j.ijsu.2022.106789. View

20.

Duval S, Tweedie R . Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000; 56(2):455-63. DOI: 10.1111/j.0006-341x.2000.00455.x. View