A comparative study on surgical management of long-course symptomatic cervical OPLL between anterior en bloc resection and posterior laminectomy with fusion

Background context: There is a lack of research specifically comparing the efficacy of anterior cervical ossified posterior longitudinal ligament (OPLL) en bloc resection (ACOE) with posterior laminectomy with fusion (PLF) in patients with long course (≥ 24 months) cervical OPLL. Purpose To compare ACOE vs. PLF for management of patients with long-course cervical OPLL. Study design: A retrospective case-control study. Patient sample: Included in this study were 112 patients with long-course OPLL in our center between January 2012 and August 2021 with a mean age of 59.11 years. Of them, 64 patients (39 males and 25 females; mean age 58.14 years) were underwent ACOE, and the remaining 48 patients (43 males and 5 females; mean age 60.40 years) were underwent PLF. Outcome measures: Demographic information, OPLL index, canal occupying ratio (COR), neck Visual Analogue Scale (VAS) pain score, Japanese Orthopedic Association (JOA) score and JOA recovery rate (JOA-RR) were collected and analyzed. Methods All patients were followed up for 48 months postoperatively, during which neurological and radiological outcomes were compared between the two groups. Results The mean operative time and intraoperative blood loss in ACOE group was significantly shorter and less than those in PLF group. The mean final JOA score and JOA-RR (%) in ACOE group were significantly higher than those in PLF group. There was no significant difference in the mean final VAS score and complication rate between the two groups. Conclusions Both ACOE and PLF were effective in improving neurological function in patients with long-course OPLL. However, ACOE offered shorter operative time and less intraoperative blood loss, and better neurological recovery, especially in patients with COR ≥ 50% and K-line negativity. There was no significant difference in the incidence of complications between the two groups. PLF may be preferable to patients with long-segment OPLL.