Is anterior decompression and fusion more beneficial than laminoplasty for K-line (+) cervical ossification of the posterior longitudinal ligament? An analysis using propensity score matching

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  • 1 Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba;
  • | 2 Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo;
  • | 3 Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama;
  • | 4 Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyoda-yu, Tokyo;
  • | 5 Department of Orthopedic Surgery, Wakayama Medical University Kihoku Hospital, Ito-gun, Wakayama;
  • | 6 Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori;
  • | 7 Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata;
  • | 8 Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki;
  • | 9 Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi;
  • | 10 Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo;
  • | 11 Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi;
  • | 12 Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka;
  • | 13 Department of Orthopedic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo;
  • | 14 Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi;
  • | 15 Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido;
  • | 16 Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga;
  • | 17 Department of Orthopedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Fukui;
  • | 18 Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo;
  • | 19 Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshima;
  • | 20 Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka;
  • | 21 Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka;
  • | 22 Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka;
  • | 23 Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa;
  • | 24 Department of Orthopedic Surgery, University of Yamanashi, Chuo, Yamanashi;
  • | 25 Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi;
  • | 26 Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto;
  • | 27 Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa;
  • | 28 Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi; and
  • | 29 Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Japan
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OBJECTIVE

It is unclear whether anterior cervical decompression and fusion (ADF) or laminoplasty (LMP) results in better outcomes for patients with K-line–positive (+) cervical ossification of the posterior longitudinal ligament (OPLL). The purpose of the study is to compare surgical outcomes and complications of ADF versus LMP in patients with K-line (+) OPLL.

METHODS

The study included 478 patients enrolled in the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament and who underwent surgical treatment for cervical OPLL. The patients who underwent anterior-posterior combined surgery or posterior decompression with instrumented fusion were excluded. The patients with a follow-up period of fewer than 2 years were also excluded, leaving 198 patients with K-line (+) OPLL. Propensity score matching was performed on 198 patients with K-line (+) OPLL who underwent ADF (44 patients) or LMP (154 patients), resulting in 39 pairs of patients based on the following predictors for surgical outcomes: age, preoperative Japanese Orthopaedic Association (JOA) score, C2–7 angle, and the occupying ratio of OPLL. Clinical outcomes were assessed 1 and 2 years after surgery using the recovery rate of the JOA score. Complications and reoperation rates were also investigated.

RESULTS

The mean recovery rate of the JOA score 1 year after surgery was 55.3% for patients who underwent ADF and 42.3% (p = 0.06) for patients who underwent LMP. Two years after surgery, the recovery rate was 53.4% for those who underwent ADF and 38.7% for LMP (p = 0.07). Although both surgical procedures yielded good results, the mean recovery rate of JOA scores tended to be higher in the ADF group. The incidence of surgical complications, however, was higher following ADF (33%) than LMP (15%; p = 0.06). The reoperation rate was also higher in the ADF group (15%) than in the LMP group (0%; p = 0.01).

CONCLUSIONS

Clinical outcomes were good for both ADF and LMP, indicating that ADF and LMP are appropriate procedures for patients with K-line (+) OPLL. Clinical outcomes of ADF 1 and 2 years after surgery tended to be better than LMP, but the analysis did not detect any significant difference in clinical outcomes between the groups. Conversely, patients who underwent ADF had a higher incidence of surgery-related complications. When considering indications for ADF or LMP, benefits and risks of the surgical procedures should be carefully weighed.

ABBREVIATIONS

ADF = anterior cervical decompression and fusion; JOA = Japanese Orthopaedic Association; LMP = laminoplasty; OPLL = ossification of the posterior longitudinal ligament; PDF = posterior decompression with instrumented fusion; ROM = range of motion; VAS = visual analog scale.

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