Anterior Approach Versus Posterior Surgical Approach For Treatment Of Ossification Of Posterior Longitudinal Ligament In The Cervical Spine: A Meta Analysis

Purpose: To compare the outcomes of the anterior and posterior surgical approaches for the treatment of cervical ossification of the posterior longitudinal ligament(OPLL).Methods: Randomized controlled trials(RCTs)and non-RCT studies comparing the anterior and posterior surgical approaches for the treatment of OPLL were retrieved from Pub Med,EMBASE,the Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure(CNKI),and Wanfang database after a systematic search.For entries made up to April 30,2022.The studies were assessed for quality using the Newcastle-Ottawa Scale.The main endpoints in the studies were pre-and postoperative Japanese orthopedic association(JOA)scores;rates of neurological recovery,complications,and reoperation;operation time;and amount of blood loss.Additionally,the anterior approach(ADF,ACCF,ACAF)was individually compared with the laminoplasty and laminectomy types of posterior cervical approaches.Results: Sixteen cohort studies and two RCT,involving 1236 patients in all,were analyzed.The meta-analysis showed that both anterior and posterior approaches were similar in preoperative JOA scores and amount of intraoperative blood loss(P > 0.05)and differed significantly in frequency of complications,reoperation rates,and operation time(P < 0.05).Subgroup analysis showed that the postoperative JOA scores and recovery rate were significantly greater for the anterior approach than either of the posterior approaches(P<0.05).Conclusion: Both anterior and posterior surgical methods have their advantages and disadvantages for the treatment of OPLL,and the clinical benefits and safety of surgery in each case need to be weighed before the operation is performed.In situations where neurologic outcomes need to be optimized,such as in younger age groups and in patients with good preoperative general condition,anterior surgery is preferred over posterior surgery.On the other hand,if the patient is in poor preoperative condition or older,due to the lower incidence of surgical complications,reoperation,and surgical trauma,posterior surgery should be used.However,with the advent of ACAF technology,for patients suitable for ACAF technology,it can have the advantages of high neurological recovery rate of anterior surgery and low complication rate and less trauma of posterior surgery,and ACAF technology can be considered when dealing with multilevel severe OPLL,but further well-designed,large-scale,long-term randomized controlled trials are needed to confirm this new surgical method.