A meta-analysis of the efficacies of laminoplasty versus laminectomy and fusion in the treatment of multi-level ossification of the posterior longitudinal ligament in the cervical spine

English Keywords:Multi-level ossification of the posterior longitudinal ligament in the cervical spine  Laminoplasty  Laminectomy and fusion  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacies of laminoplasty(LP) and laminectomy and fusion(LF) in the treatment of multi-level ossification of the posterior longitudinal ligament(OPLL) in the cervical spine through meta-analysis. Methods: The databases of CNKI, Wanfang, Pubmed, Cochrane Library, EMBASE were searched by computer from their inceptions to June 2023 and the published clinical studies comparing LP and LF in the treatment of multi-level OPLL in the cervical spine were included. Cochrane risk bias assessment tool and Newcastle-Ottawa scale(NOS) were used to evaluate the quality of the included studies. Relevant data including operation time, intraoperative blood loss, the improvement rate of Japanese Orthopaedic Association(JOA) score, the change value of visual analogue scale(VAS) score, neck disability index(NDI), cervical curvature index(CCI), sagittal vertical axis(SVA) and cervical range of motion(CROM) at the final follow-up, the postoperative complication rate and OPLL progression rate were extracted and sorted. Then the meta-analysis was conducted by RevMan 5.4 and StataSE 16.0 softwares. Results: 12 literatures(3 randomized controlled studies and 9 cohort studies) were ultimately included, involving a total sample size of 1496 cases, containing 839 cases in the LP group and 657 cases in the LF group. The results of meta-analysis were as follows: the LP group was better than LF group with significant differences in operation time[WMD=-28.01, 95%CI(-36.25,-19.77), P<0.00001], intraoperative blood loss[WMD=-115.09, 95%CI(-197.91, -32.27), P=0.006], the change value of CROM[WMD=-7.83, 95%CI(-8.10, -7.55), P<0.00001] compared with those before surgery at final follow-up, the incidence of postoperative C5 nerve root paralysis[OR=0.32, 95%CI(0.21, 0.50), P<0.00001] and axial symptoms[OR=0.44, 95%CI(0.28, 0.71), P=0.0006]. The LF group was better than the LP group with significant differences in the change value of the CCI[WMD=-0.75, 95%CI(-0.92, -0.58), P<0.00001] and SVA[WMD=5.49, 95%CI(5.30, 5.68), P<0.00001] compared with those before surgery at final follow-up, and the postoperative OPLL progression rate[OR=1.76, 95%CI(1.26, 2.46), P=0.0009]. There were no significant differences between the two groups in the improvement rate of JOA score[WMD=-1.24, 95%CI(-4.02, 1.54), P=0.38], the change value of VAS[WMD=0.03, 95%CI(-0.43, 0.49), P=0.89] and NDI[WMD＝0.54, 95%CI(-0.07, 1.14), P=0.08] compared with those before surgery at final follow-up, the incidence of postoperative cerebrospinal fluid leakage[OR=0.58, 95%CI(0.24, 1.39), P=0.22], incision infection[OR=0.71, 95%CI(0.32, 1.57), P=0.39] and epidural hematoma[OR=0.37, 95%CI(0.06, 2.16), P=0.27]. Conclusions: Both LF and LP can effectively treat multi-level OPLL in the cervical spine and improve the neurological function of patients. Compared to LF, LP causes less surgical damage, preserves more cervical mobility and additionally, has a lower incidence of the postoperative C5 nerve root paralysis and axial symptoms. In comparison, LF can better maintain the curvature and stability of the cervical spine and delay the progression of ossification.