Impact of Door-Opening Side Selection on Surgical Outcomes in single-door cervical laminoplasty for Asymmetric Ossification of the Posterior Longitudinal Ligament

Background This study investigates the impact of the choice of door-opening side on neurological recovery, radiographic decompression adequacy, and complications in patients with asymmetric ossification of the posterior longitudinal ligament (OPLL), so as to provide evidence-based guidance for the selection of surgical side . Methods A retrospective analysis was performed on the data of 35 patients with asymmetric C-OPLL who underwent cervical posterior single-door laminoplasty (CPSDL) from September 2020 to January 2024. Patients were divided into two groups: the ipsilateral group, when the door-opening side was consistent with the predominant OPLL occupation side, and the contralateral group, when the door-opening side was inconsistent with the predominant OPLL occupation. The following parameters were evaluated: Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) for pain, C2–7 Cobb angle, sagittal diameter of the cervical canal, C2–7 sagittal vertical axis (SVA), axial length and thickness of ossified lesions. Clinical outcomes were compared between the two groups to comprehensively evaluate the impact of the choice of door-opening sidein asymmetric OPLL. Results There were no significant differences between the two groups in postoperative Neck Disability Index (NDI) score, C2-7 SVA, incidence of C5 nerve root palsy, and axial symptoms, and total incidence of complications. The ipsilateral group had more significant improvements in C2-7 Cobb angle, sagittal diameter of cervical spinal canal, VAS, and JOA score. Conclusion For patients with asymmetric C-OPLL, the predominant OPLL occupation side is preferred as the door-opening side in CPSDL