Comparison of Anterior Controllable Antedisplacement and Fusion Versus Laminoplasty in the Treatment of Multisegment Ossification of Cervical Posterior Longitudinal Ligament: A Meta-Analysis of Clinical

Yiming Zhang; Zhen Huang; Peng Xu; Zhentao Xu; Xiaohui Xing; Yexin Xin; Mingxu Gao; Xueyuan Li; Yilei Xiao

doi:10.1016/j.wneu.2023.12.126

Comparison of Anterior Controllable Antedisplacement and Fusion Versus Laminoplasty in the Treatment of Multisegment Ossification of Cervical Posterior Longitudinal Ligament: A Meta-Analysis of Clinical

World Neurosurg. 2023 Dec 28:185:193-206. doi: 10.1016/j.wneu.2023.12.126. Online ahead of print.

Authors

Yiming Zhang¹, Zhen Huang¹, Peng Xu¹, Zhentao Xu¹, Xiaohui Xing¹, Yexin Xin², Mingxu Gao¹, Xueyuan Li¹, Yilei Xiao³

Affiliations

¹ Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China.
² Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China; School of Clinical Medicine, Weifang Medical University, Weifang, Shangdong, China.
³ Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China. Electronic address: xiaoyilei@lcu.edu.cn.

PMID: 38157983
DOI: 10.1016/j.wneu.2023.12.126

Abstract

Objective: This study aims to provide a comprehensive summary of the existing literature and conduct a systematic evaluation of the clinical outcomes associated with anterior controllable antedisplacement and fusion (ACAF) and posterior laminoplasty (LP) for the treatment of multisegment ossification of the cervical posterior longitudinal ligament (OPLL).

Methods: We conducted an electronic search of databases, including PubMed, Embase, Cochrane Library, and CNKI, from the inception of the initial database to March 2023. We analyzed various parameters, including demographic data, operation time, intraoperative blood loss, cervical curvature, Japanese Orthopaedic Association (JOA) scores, Visual Analog Scale (VAS) scores, and postoperative complications. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.4 software.

Results: Our evaluation encompassed 7 studies involving a total of 467 patients. The patient cohort was divided into 2 groups: Group A (ACAF) comprised 226 patients, while Group B (LP) comprised 241 patients. Overall, our statistical analysis revealed significant differences between the 2 groups (P < 0.05) in terms of intraoperative blood loss, operative time, JOA score, JOA score improvement rate, postoperative VAS score, postoperative cervical curvature, and the incidence of certain postoperative complications (C5 nerve root paralysis, dysphagia, and axial symptoms). However, there was no statistically significant difference in the incidence of postoperative cerebrospinal fluid leakage and postoperative total complications between the 2 groups (P > 0.05).

Conclusions: The findings of this study suggest that, in the treatment of multilevel cervical OPLL, ACAF yields superior outcomes compared to LP. Specifically, ACAF improves postoperative neurologic function, reduces postoperative pain, lowers intraoperative blood loss, improves postoperative cervical curvature, and decreases the incidence of C5 nerve root paralysis and postoperative axial symptoms. Nonetheless, ACAF is associated with longer operative times and a higher incidence of postoperative dysphagia, though the overall incidence of postoperative complications is similar. It is important to note that these conclusions should be interpreted cautiously due to the limited sample size and the variable quality of the included studies. Further research involving larger, high-quality studies is warranted to validate these findings.

Keywords: ACAF; ACCF; ACDF; JOA; LP; Meta-analysis; OPLL; RR; VAS; VOC.

Publication types

Review