Does instrumented fusion improve clinical outcomes in posterior surgery for cervical ossification of the posterior longitudinal ligament? A systematic review and meta-analysis.
Hiroshi Takahashi, Narihito Nagoshi, Takashi Hirai et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared laminoplasty (LAMP) with posterior decompression and fusion (PDF) for cervical ossification of the posterior longitudinal ligament. Seventeen studies were included. Overall neurological recovery was similar between procedures, while subgroup analysis found significantly greater improvement with PDF among patients with K-line (-) OPLL. Neck Disability Index scores and sagittal alignment measures were similar. Postoperative neck pain and complications were more frequent with PDF. The authors caution that the subgroup finding is hypothesis-generating because the included studies were observational and the certainty of evidence was very low.
Key findings
- Across 17 included studies, overall neurological recovery was similar after LAMP and PDF.
- PDF was associated with significantly greater neurological improvement in patients with K-line (-) OPLL.
- Postoperative neck pain and complication rates were higher with PDF; Neck Disability Index scores and sagittal alignment were similar.
Why it matters
The comparison highlights a potential trade-off in posterior surgery for cervical OPLL: PDF may offer greater neurological improvement in the K-line (-) subgroup, but was associated with more neck pain and complications. Because the evidence is observational and very low certainty, these findings inform clinical discussion but do not establish that one procedure is generally superior.
What to keep in mind
The included studies were observational, and the certainty of evidence was very low; the K-line (-) subgroup result should be considered hypothesis-generating.