Surgical Approaches for the Treatment of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: Results of a Decision Analysis.

Surgical Approaches for the Treatment of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: Results of a Decision Analysis.

World Neurosurg. 2018 Jan 16;:

Authors: Nayak NR, Piazza M, Milby A, Thawani JP, Smith LJ, Stein SC, Malhotra NR

Abstract
BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) often leads to cervical myelopathy. While multiple procedures have been shown to be effective in the treatment of OPLL, outcomes are less predictable than in degenerative cervical myelopathy and surgery is associated with high rates of complications and re-operation which affect quality of life. In this study, we perform a decision analysis utilizing post-operative complication data and health-related quality of life (HRQoL) utility scores to assess the average expected health utility and 5-year quality-adjusted life years (QALYs) associated with the most common surgical approaches for multilevel cervical OPLL.
METHODS: We searched Medline, EMBASE and the Cochrane Library for relevant articles published between 1990 and October 2017. Meta-analytically pooled complication data and HRQoL utility scores associated with each complication were evaluated in a long term model.
RESULTS: The overall incidence of peri-operative complications ranged from 6.2% for laminectomy alone to 11.0% for anterior decompression and fusion. Revision surgery for hardware/fusion failure or progression was highest in for laminectomy alone (3.0%) and lowest for laminectomy and fusion (1.6%). Laminoplasty resulted in the highest 5-year QALYs gained, compared with laminectomy and anterior approaches (p < 0.001). There was no significant difference in QALY gained between laminectomy-fusion and laminoplasty.
CONCLUSION: The results suggest that due to higher rates of complications associated with anterior cervical approaches, laminoplasty may result in improved long-term outcomes from an HRQoL standpoint. These findings may guide surgeons in cases where either procedure is a reasonable option.

PMID: 29355800 [PubMed - as supplied by publisher]

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