Comparison Of Interventions For Cervical Ossification Of Posterior Longitudinal Ligament: A Systematic Review And Network Meta-Analysis

OBJECTIVE: To summarize the literature and systematically evaluate out-comes for ossification of posterior longitudinal ligament interventions including anterior cervical corpectomy and fusion (ACCF), anterior controllable ante-displacement and fusion (ACAF), laminoplasty (LP), and laminectomy with fusion (LF). -METHODS: We searched PubMed, Embase, Web of Science, and the Cochrane Library from January 1990 to March 2021. Patient demographic data, Japanese Orthopaedic Association score, cervical lordosis and overall com-plications were analyzed. RESULTS: We evaluated 30 studies involving 2038 patients. Patients under -going ACCF had improved Japanese Orthopaedic Association scores compared with patients undergoing LP (weighted mean difference [WMD] 1.17, 95% con-fidence interval [CI] 0.49-1.85) and LF (WMD 1.21, 95% CI 0.17-2.24). Patients with ACAF had better cervical lordosis compared with patients with ACCF (WMD 7.00, 95% CI 0.72-13.27), LP (WMD 10.27, 95% CI 4.64-15.90), and LF (WMD 8.98, 95% CI 2.48-15.47). Additionally, ACAF (odds ratio 0.24, 95% CI 0.07-0.84) and LP (odds ratio 0.50, 95% CI 0.28-0.90) had a lower incidence of complica-tions compared with ACCF. CONCLUSIONS: Japanese Orthopaedic Association score outcomes indi-cated that ACCF was superior to LP and LF. ACAF had the largest cervical lordosis among all procedures. ACCF showed a higher incidence of overall complications compared with ACAF and LP.