Comparative Effectiveness and Safety of Anterior Cervical Corpectomy with Fusion, Laminoplasty, and Laminectomy and Instrumented Fusion for Ossification of the Posterior Longitudinal Ligament: A Systematic Review and Network Meta-Analysis

Abstract

Background

To evaluate the comparative effectiveness and safety of anterior cervical corpectomy with fusion (ACCF), laminoplasty (LP), and laminectomy and instrumented fusion (LF) in the treatment of ossification of the posterior longitudinal ligament (OPLL).

Methods

Embase, Pubmed, and Cochrane library were searched from their date of inception to June 13, 2020. Relevant randomized controlled trials (RCTs) and cohort studies comparing different procedures among ACCF, LP, and LF were identified, data were extracted to perform a network meta-analysis (NMA). The outcomes were the Japanese Orthopedic Association (JOA) score and complications.

Results

We deemed 14 trials eligible, including 877 patients. In NMA, ACCF showed a significant improvement of JOA score compared with LP [MD= −0.89, 95% CI (–1.73, −0.18)], but no significant difference was found when compared LF with ACCF or LP. No significant differences in complications were found when compared LF with LP or ACCF, while ACCF showed significantly higher in complications than LP [OR = 1.99, 95% CI (1.10, 3.35)]. The surface under the cumulative ranking curves (SUCRA) showed that the rank of JOA score improvement is as follows: ACCF (82.5%), LF (79.5%), and LP (2.3%). And the rank of complication rate is as follows: LF (65.8%), ACCF (68.4%), and LP (2.1%).

Limitation

The biggest limitation was that none of the included studies were RCTs.

Conclusions

Despite the higher probability of complications than LP, ACCF was the more recommended procedure for its highest ranking spectrums of JOA score improvement to treat the OPLL.

Keywords:

• Laminoplasty
• anterior cervical corpectomy with fusion
• laminectomy and instrumented fusion
• network meta-analysis

Acknowledgments

The authors thank Ms. Weiran Ye for her kind help during the preparation of the manuscript.

Disclosure statement

The authors have no conflicts of interest to declare.