title: Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis.
abstract: OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior decompression alone in patients with OPLL. These results indicate that surgical decompression and fusion lead to a faster recovery, improved postoperative neurological functioning, and a lower incidence of OPLL progression compared with posterior decompression only. Furthermore, decompression and fusion did not lead to a greater incidence of complications compared with posterior decompression only.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Syed K
authors.initials: SK
authors.lastname: Mehdi
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Alentado
authors.affiliation: Department of Neurological Surgery, Cleveland Clinic; and.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Center for Spine Health and.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.affiliation: Center for Spine Health and.|Department of Neurological Surgery, Cleveland Clinic; and.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Center for Spine Health and.|Department of Neurological Surgery, Cleveland Clinic; and.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
keywords: ADF = anterior decompression and fusion; JOA = Japanese Orthopaedic Association; MCID = minimal clinically important difference; OPLL = ossification of the posterior longitudinal ligament; OPLL progression; PDF = posterior decompression and fusion; PRO = patient-reported outcome; cervical myelopathy; complications; decompression; fusion; ossification of the posterior longitudinal ligament; outcomes