Skip to main content
SpringerLink
Log in

Posterior decompression and fusion versus laminoplasty for cervical ossification of posterior longitudinal ligament: a systematic review and meta-analysis

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Both posterior decompression and fusion (PDF) and laminoplasty (LAMP) have been used to treat cervical myelopathy due to multilevel ossification of posterior longitudinal ligament (OPLL). However, considerable controversy exists over the choice of the two surgical strategies. Thus, the aim of this study is to compare clinical outcomes of PDF and LAMP for treatment of cervical myelopathy due to multilevel OPLL. We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials database to identify relevant clinical studies compared with clinical outcomes of PDF and LAMP for cervical OPLL. The primary outcomes including Japanese Orthopaedic Association (JOA) score and recovery rate of JOA were evaluated, and the secondary outcomes involving visual analogue scale (VAS), cervical curvature, OPLL progression rate, complication rate, reoperation rate and surgical trauma were also evaluated using Stata software. A total of nine studies were included in the current study, involving 324 patients. The current study suggests that compared with LAMP, PDF achieves a lower OPLL progression rate, better postoperative cervical curvature and similar neurological improvement in the treatment of multilevel cervical OPLL. However, PDF has a higher complication rate, more surgical trauma and higher postoperative VAS than LAMP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. An HS, Al-Shihabi L, Kurd M (2014) Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine. J Am Acad Orthop Surg 22:420–429

    Article  PubMed  Google Scholar 

  2. Adogwa O, Huang K, Hazzard M, Chagoya G, Owens R, Cheng J, Ugiliweneza B, Boakye M, Lad SP (2015) Outcomes after cervical laminectomy with instrumented fusion versus expansile laminoplasty: a propensity matched study of 3185 patients. J Clin Neurosci 22(3):549–553

    Article  PubMed  Google Scholar 

  3. Blizzard DJ, Caputo AM, Sheets CZ (2017) Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up. Eur Spine J 26(1):85–93

    Article  PubMed  Google Scholar 

  4. Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J (2011) Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech 24:24–30

    Article  CAS  PubMed  Google Scholar 

  5. Denaro V, Longo UG, Berton A, Salvatore G, Denaro L (2015) Cervical spondylotic myelopathy: the relevance of the spinal cord back shift after posterior multilevel decompression. A systematic review. Eur Spine J 24(S7):832–841

    Article  PubMed  Google Scholar 

  6. Egger M, Smith GD, Schneider M, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Furlan JC, Catharine Craven B (2016) Psychometric analysis and critical appraisal of the original, revised, and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy. Neurosurg Focus 40(6):E6

    Article  PubMed  Google Scholar 

  8. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA (2007) Anterior cervical discectomy and fusion associated complications. Spine 32(21):2310–2317

    Article  PubMed  Google Scholar 

  9. Houten JK, Cooper PR (2003) Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery 52:1081–1087

    PubMed  Google Scholar 

  10. Highsmith JM, Dhall SS, Haid RW Jr, Rodts GE Jr, Mummaneni PV (2011) Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine 14:619–625

    Article  PubMed  Google Scholar 

  11. Heller JG, Edwards CC, Murakami H, Rodts GE (2001) Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine 26:1330–1336

    Article  CAS  PubMed  Google Scholar 

  12. Hasegawa K, Hirano T, Shimoda H, Homma T, Morita O (2008) Indications for cervical pedicle screw instrumentation in nontraumatic lesions. Spine 33(21):2284–2289

    Article  PubMed  Google Scholar 

  13. Hojo Y, Ito M, Abumi K, Kotani Y, Sudo H, Takahata M, Minami A (2011) A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J 20:890–898

    Article  PubMed  Google Scholar 

  14. Harman F, Kaptanoglu E, Hasturk AE (2016) Esophageal perforation after anterior cervical surgery: a review of the literature for over half a century with a demonstrative case and a proposed novel algorithm. Eur Spine J 25(7):2037–2049

    Article  PubMed  Google Scholar 

  15. Hori T, Kawaguchi Y, Kimura T (2006) How does the ossification area of the posterior longitudinal ligament progress after cervical laminoplasty? Spine 31(24):2807–2812

    Article  PubMed  Google Scholar 

  16. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  PubMed  Google Scholar 

  17. Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, Yoshikawa H (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament. Part 1: clinical results and limitations of laminoplasty. Spine 32:647–653

    Article  PubMed  Google Scholar 

  18. Joseph V, Kumar GS, Rajshekhar V (2009) Cerebrospinal fluid leak during cervical corpectomy for ossifed posterior longitudinal ligament: incidence, management, and outcome. Spine 34:491–494

    Article  PubMed  Google Scholar 

  19. Katsumi K, Izumi T, Ito T, Hirano T, Watanabe K, Ohashi M (2016) Posterior instrumented fusion suppresses the progression of ossification of the posterior longitudinal ligament: a comparison of laminoplasty with and without instrumented fusion by three-dimensional analysis. Spine J 25(5):1634–1640

    Google Scholar 

  20. Kawaguchi Y, Kanamori M, Ishihara H, Nakamura H, Sugimori K, Tsuji H (2001) Progression of ossification of the posterior longitudinal ligament following en bloc cervical laminoplasty. J Bone Joint Surg Am 83:1798–1802

    Article  CAS  PubMed  Google Scholar 

  21. Koda M, Mochizuki M, Konishi H, Aiba A, Kadota R, Inada T, Kamiya K, Ota M, Maki S, Takahashi K, Yamazaki M, Mannoji C, Furuya T (2016) Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (-) cervical ossification of the posterior longitudinal ligament. Eur Spine J 25(7):2294–2301

    Article  PubMed  Google Scholar 

  22. Kumar VGR, Rea GL, Mervis LJ, McGregor JM (1999) Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery 44:771–777

    Article  CAS  PubMed  Google Scholar 

  23. Liu X, Chen Y, Yang H, Li T, Xu B, Chen D (2017) Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis. Eur Spine J 26(4):1173–1180

    Article  PubMed  Google Scholar 

  24. Lee CH, Jahng TA, Hyun SJ, Kim KJ, Kim HJ (2016) Expansive laminoplasty versus laminectomy alone versus laminectomy and fusion for cervical ossification of the posterior longitudinal ligament: is there a difference in the clinical outcome and sagittal alignment? Clin Spine Surg 29(1):E9–E15

  25. Lee CH, Sohn MJ, Lee CH, Choi CY, Han SR, Choi BW (2016) Are there differences in the progression of ossification of the posterior longitudinal ligament following laminoplasty versus fusion? A meta-analysis. Spine 42(12):887

    Article  Google Scholar 

  26. Lee JJ, Shin DA, Yi S, Kim KN, Yoon DH, Shin HC (2018) Effect of posterior instrumented fusion on three-dimensional volumetric growth of cervical ossification of the posterior longitudinal ligament: a multiple regression analysis. Spine J S1529-9430(18):30085–30088

    Google Scholar 

  27. Manzano GR, Casella G, Wang MY, Vanni S, Levi AD (2012) A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery 70:264–277

    Article  PubMed  Google Scholar 

  28. Matsunaga S, Sakou T (2012) Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. Spine 37:E309–E314

    Article  PubMed  Google Scholar 

  29. Masaki Y, Yamazaki M, Okawa A, Aramomi M, Hashimoto M, Koda M, Mochizuki M, Moriya H (2007) An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech 20(1):7–13

    Article  PubMed  Google Scholar 

  30. Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG (2015) Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine 40(12):E675–E693

    Article  PubMed  Google Scholar 

  31. Ota M, Furuya T, Maki S, Inada T, Kamiya K, Ijima Y, Saito J, Takahashi K, Yamazaki M, Aramomi M, Mannoji C, Koda M (2016) Addition of instrumented fusion after posterior decompression surgery suppresses thickening of ossification of the posterior longitudinal ligament of the cervical spine. J Clin Neurosci 34:162–165

    Article  PubMed  Google Scholar 

  32. Rhee JM, Basra S (2008) Posterior surgery for cervical myelopathy: laminectomy, laminectomy with fusion, and laminoplasty. Asian Spine J 2(2):114–126

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rubin CT, Hausman MR (1988) The cellular basis of Wolff’s law. Transduction of physical stimuli to skeletal adaptation. Rheum Dis Clin North Am 14:503–517

    Article  CAS  PubMed  Google Scholar 

  34. Sagi HC, Beutler W, Carroll E, Connolly PJ (2002) Airway complications associated with surgery on the anterior cervical spine. Spine 27(9):949–953

    Article  PubMed  Google Scholar 

  35. Smith ZA, Buchanan CC, Raphael D, Khoo LT (2011) Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches. Neurosurg Focus 30:E10

    Article  PubMed  Google Scholar 

  36. Saito J, Maki S, Kamiya K, Furuya T, Inada T, Ota M, Iijima Y, Takahashi K, Yamazaki M, Aramomi M, Mannoji C, Koda M (2016) Outcome of posterior decompression with instrumented fusion surgery for K-line (-) cervical ossification of the longitudinal ligament. J Clin Neurosci 32:57–60

    Article  PubMed  Google Scholar 

  37. Sakai K, Okawa A, Takahashi M, Arai Y, Kawabata S, Enomoto M, Kato T, Hirai T, Shinomiya K (2012) Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine 37:367–376

    Article  PubMed  Google Scholar 

  38. Scheer JK, Tang JA, Smith JS, Acosta FL Jr, Protopsaltis TS, Blondel B (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19:141–159

    Article  PubMed  Google Scholar 

  39. Tang HM, Yeh KT, Lee RP, Chen IH, Yu TC, Liu KL (2016) Combined expansive open-door laminoplasty with short-segment lateral mass instrumented fusion for multilevel cervical spondylotic myelopathy with short segment instability. Tzu-chi Medical Journal 28:15–19

    Article  PubMed  Google Scholar 

  40. Taketomi E (1997) Progression of ossification of the posterior longitudinal ligament in the cervical spine. J Jpn Spine Res Soc 8:359–366

    Google Scholar 

  41. Woods BI, Hohl J, Lee J, Donaldson W, Kang J (2011) Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res 469:688–695

    Article  PubMed  Google Scholar 

  42. Wells G, Shea B, O’Connell D (2016) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

  43. Yang L, Gu Y, Shi J, Gao R, Liu Y, Li J, Yuan W (2013) Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics 36(1):e79–e87

    Article  PubMed  Google Scholar 

  44. Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA (2011) Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol 106(11):1911–1921

    Article  PubMed  PubMed Central  Google Scholar 

  45. Yuan W, Zhu Y, Liu X, Zhu H, Zhou X, Zhou R, Cui C, Li J (2015) Postoperative three-dimensional cervical range of motion and neurological outcomes in patients with cervical ossification of the posterior longitudinal ligament: cervical laminoplasty versus laminectomy with fusion. Clin Neurol Neurosurg 134:17–23

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by grants from the National Natural Science Foundation of China (Nos. 81874027, 31970862) and Guangzhou Municipal Science and Technology project (Nos. 201803010001).

Author information

Authors and Affiliations

  1. Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, 601 West Whampoa Avenue, Guangzhou, 510000, China

    Ping Xu, Guo-Dong Sun, Shi-Shu Huang & Zhi-Zhong Li

  2. International School of Jinan University, 601 West Whampoa Avenue, Guangzhou, 510000, China

    Lu Xun

  3. Heyuan Affiliated Hospital of Jinan University, 733 Wenxiang Road City, Heyuan, 517000, China

    Zhi-Zhong Li

Authors
  1. Ping Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guo-Dong Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lu Xun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shi-Shu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhi-Zhong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Shi-Shu Huang or Zhi-Zhong Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval not applicable as this is a systematic review and meta-analysis.

Informed consent

This is a systematic review and meta-analysis so for this type of study informed consent is not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Investigation performed at the Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, People’s Republic of China.

Electronic supplementary material

Appendix 1

The forest plot shows the sensitive analysis of preoperative C2-C7 Cobb angle. The size of the squares reflects the weight of the trial in pooled analysis. The horizontal bars represent the 95% CI. SMD = standardized mean difference. PDF = posterior decompression and fusion. LAMP = laminoplasty. (PNG 303 kb)

High Resolution Image (TIF 3684 kb)

Appendix 2

The forest plot shows the sensitive analysis of postoperative JOA score. The size of the squares reflects the weight of the trial in pooled analysis. The horizontal bars represent the 95% CI. SMD= standardized mean difference. PDF = posterior decompression and fusion. LAMP = laminoplasty. JOA= Japanese Orthopaedic Association. (PNG 369 kb)

High Resolution Image (TIF 3603 kb)

Appendix 3

The forest plot shows the sensitive analysis of postoperative C2-C7 Cobb angle. The size of the squares reflects the weight of the trial in pooled analysis. The horizontal bars represent the 95% CI. SMD = standardized mean difference. PDF = posterior decompression and fusion. LAMP = laminoplasty. (PNG 240 kb)

High Resolution Image (TIF 3815 kb)

Appendix 4

The forest plot shows the sensitive analysis of recovery rate. The size of the squares reflects the weight of the trial in pooled analysis. The horizontal bars represent the 95% CI. SMD = standardized mean difference. PDF = posterior decompression and fusion. LAMP = laminoplasty. (PNG 244 kb)

High Resolution Image (TIF 3801 kb)

Appendix 5

The forest plot shows the sensitive analysis of operation time. The size of the squares reflects the weight of the trial in pooled analysis. The horizontal bars represent the 95% CI. SMD = standardized mean difference. PDF = posterior decompression and fusion. LAMP = laminoplasty. (PNG 267 kb)

High Resolution Image (TIF 3750 kb)

Appendix 6

The forest plot shows the sensitive analysis of blood loss. The size of the squares reflects the weight of the trial in pooled analysis. The horizontal bars represent the 95% CI. SMD = standardized mean difference. PDF = posterior decompression and fusion. LAMP = laminoplasty. (PNG 315 kb)

High Resolution Image (TIF 3679 kb)

ESM 1

(DOC 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, P., Sun, GD., Xun, L. et al. Posterior decompression and fusion versus laminoplasty for cervical ossification of posterior longitudinal ligament: a systematic review and meta-analysis. Neurosurg Rev 44, 1457–1469 (2021). https://doi.org/10.1007/s10143-020-01317-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-020-01317-z

Keywords

Search

Navigation