Comparison of Anterior versus Posterior Approach for the Treatment of Cervical Compressive Myelopathy Due to Ossification of the Posterior Longitudinal Ligament

Abstract Background Cervical myelopathy is a dysfunction of the spinal cord. It is often caused by a narrowing of the cervical spinal canal. Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly. Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). The pathogenesis of OPLL is poorly understood. Some have suggested it as a variant of diffuse idiopathic skeletal hyperostosis (DISH). Purpose The purpose of the study is to perform a systematic review and meta-analysis to evaluate the Clinical results of anterior and posterior approaches for the treatment of cervical compressive myelopathy Due to cervical ossification of the posterior longitudinal ligament (OPLL). Methods Randomized clinical trials, prospective cohort, retrospective observational cohort, and case-control Studies that compare the surgical outcome of an anterior versus a posterior approach for cervical myelopathy due to OPLL from January 2006 to October 2021. Databases (PubMed, EMBASE, Cochrane library). A total of 12 studies (1070patients) were included in this systematic review and meta-analysis. Results indicated that no statistically significant differences between the anterior group and posterior group in terms of preoperative mJOA score [P = 0.23, SMD = 0.9; heterogeneity: (P = 0.85); I2 = 18%, while the postoperative JOA score was significantly higher in the anterior surgery group compared with the posterior surgery group [P 0.004, SMD = 0.67; heterogeneity: P < 0.001; I2 = 82%. The recovery rate was significantly higher in the anterior surgery group compared with the posterior surgery group of patients with canal-occupying ratio < 50%- ≥ 60% [P < 0.01, SMD = 0, 43; heterogeneity: (P < 0.57); I 2 = 91%]. The overall recovery rate (regardless the canal occupying ratio) was significantly higher in the anterior surgery group compared with the posterior surgery group [P < 0.01 SMD = 0.84. It also revealed that the postoperative complication rate [P < 0.01 OR = 1.88, operation time [P < 0.01 SMD = 1.52, intra operative blood loss [P = 0.04 SMD = 0.74 are higher in the anterior group. Conclusion Based on the results of this meta-analysis, anterior approach surgery was associated with better overall (Regardless of the canal-occupying ratio) postoperative neural function than posterior approach in the treatment of cervical compressive myelopathy due to OPLL. We thought anterior approach especially preferable to patients with canal-occupying ratio > 50%-60%, although it leads to a higher surgical trauma and incidence of surgery- related complications. Posterior approach surgery was relatively safer with lower surgical trauma and incidence of complications. We also suggest posterior approach for patients with canal-occupying ratio < 50%-60%.