title: Anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: A systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of anterior and posterior approaches for the treatment of cervical compressive myelopathy due to cervical ossification of the posterior longitudinal ligament (OPLL).
  
  
  METHODS
  Randomized controlled trials or non-randomized controlled trials published since January 1995 to October 2015 that compared the clinical effectiveness of anterior and posterior surgical approaches for the treatment of cervical OPLL were acquired by a comprehensive search in three electronic databases (PubMed, EMBASE, Cochrane library). A total of 13 studies (1050 patients) were included in this systematic review and meta-analysis.
  
  
  RESULTS
  The results indicated that no statistically significant differences between the anterior group and posterior group in terms of preoperative JOA score [P = 0.16, SMD = 0.1 (-0.04, 0.23)] and recovery rate of patients with canal-occupying ratio < 50%-60% [p = 0.89, SMD = 0.03 (-0.35, 0.41)]. The anterior group showed higher postoperative JOA score [P < 0.05, SMD = 0.23 (0.05, 0.41)], overall recovery rate (regardless of canal-occupying ratio) [P < 0.01, SMD = 0.79 (0.31, 1.27)], especially a significant higher recovery rate of patients with canal-occupying ratio > 50%-60% [P < 0.01, SMD = 1.50 (0.52, 2.47)]. However, it also revealed that the postoperative complication rate [P < 0.05, OR = 1.90 (1.08, 3.36)], blood loss [P < 0.01, SMD = 0.63 (0.34, 0.93)] and operative time [P < 0.01, SMD = 1.86 (1.07, 2.65)] were significantly higher.
  
  
  CONCLUSIONS
  Based on the results above, anterior approach surgery was associated with better overall (regardless of the canal-occupying ratio) postoperative neural function than posterior approach in the treatment of cervical compressive myelopathy due to OPLL. We thought anterior approach especially preferable to patients with canal-occupying ratio > 50%-60%, although it leads to a higher surgical trauma and incidence of surgery-related complications. Posterior approach surgery was relatively safer with lower surgical trauma and incidence of complications. We also suggest posterior approach for patients with canal-occupying ratio < 50%-60%, since the postoperative neural function was similar between the two groups for this part of patients.
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, PR China.
authors.forename: Fan
authors.initials: F
authors.lastname: Feng
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, PR China.
authors.forename: Wenfeng
authors.initials: W
authors.lastname: Ruan
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, PR China.
authors.forename: Zhengye
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, PR China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, PR China. Electronic address: doctorcailin@aliyun.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Cai
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D065228:Non-Randomized Controlled Trials as Topic; D061646:Operative Time; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
keywords: Anterior approach; Cervical ossification of the posterior longitudinal ligament; Meta-analysis; Posterior approach; Systemic review