The Risk-Effectiveness Of Anterior Versus Posterior Surgery For Multistage Cervical Ossification Of The Posterior Longitudinal Ligament

Objective: The primary goal of the study is to compare neurological outcomes and complications between anterior cervical corpectomy and fusion(ACCF)and open-door laminoplasty(ODLP)for the patient with multistage cervical ossification of the posterior longitudinal ligament(OPLL).Methods: The retrospective analysis was conducted on 117 patients with OPLL in Department of spinal surgery,the third affiliated hospital of Hebei Medical University,from April 2016 to November 2018.Finally,for various reasons,30 patients were excluded and 87 patients were included in this study.Due to the different surgical approaches,these patients were divided into the anterior cervical corpectomy and fusion Group(ACCF Group,n = 31)and open-door laminoplasty Group(ODLP Group,n =56).Patients with clinical data and basic data including age,gender,follow-up time,operation time,blood loss,area of the spinal cord(ACS),cervical curvature index(CCI),the Japanese Orthopaedic Association(JOA)score,improvement rate(IR)and the incidence of complications were collected for statistical and analysis.Results: There are 87 patients with OPLL were divided into ACCF group(n=31,35.6%)and ODLP group(n=56,64.4%).Compared with the two groups,there was no statistically significant difference in the age,gender and follow-up time and the preoperative JOA score,IR,ACS and CCI(P>0.05).Compared with the preoperative results,the JOA scores and ACS of both groups were significantly improved(all P<0.05).In postoperative follow-up,the improvement of the JOA score,ACS and CCI of the patient in ACCF group was better than that in ODLP group,showing statistical differences(all P<0.05).The operation time of the patient in ACCF group(176.56±32.11 min)longer than that in ODLP group(152.12±31.98 min)and the bleeding volume of ACCF group(388.15±101.56 ml)more than that of ODLP group(329.95±152.35 ml),with a significant different(all P<0.05).During the follow-up,9.68% patients in ACCF group experienced surgery-related complications and 3.57% in ODLP group.Conclusion: This study showed that both ACCF and ODLP could improve the neurological symptoms and the quality of life of patients.ACCF can achieve better recovery of the JOA score,IR,ACS,CCI and reconstructing the physiological curvature of the cervical spine for patients with multistage OPLL.However,for ODLP,there are better risk-Effectiveness and the operation is flexible and simple.