Review ArticleA systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament
Introduction
Ossification of the posterior longitudinal ligament (OPLL) has been known as one of the main causes of cervical myelopathy [1]. In Asian countries, the prevalence of OPLL has been 1.9% to 4.3% among individuals older than 30 years, as shown by epidemiologic studies [2], [3], [4], [5]. In contrast, the prevalence of OPLL in other continents has not been well documented. In a large cohort research by Cervical Spine Research Society in 1997, surgery for cervical OPLL remained 5% of cervical spine surgery, with possibly higher actual rate because of recent awareness of the disease among spine surgeons [6]. Although surgery is usually necessary for patients with neurologic symptoms, different operative procedures can be adopted. Although both anterior and posterior approaches for cervical OPLL have been shown effective, adverse effects or complications are frequently reported.
The overview of perioperative complications for overall cervical degenerative disease has been well described in several large cohort studies, including recent articles discussing the approach-related complications for cervical OPLL; however, few studies focus specifically on the overview of surgical complications for cervical OPLL [6], [7], [8], [9], [10], [11], [12], [13]. Cervical OPLL has unique characteristics that are different from other cervical spine degenerative diseases, such as cervical spondylotic myelopathy or cervical disc herniation. Multilevel ossification may progress postoperatively unless the ossified foci are removed. The ossified foci are also often adherent to the dura mater, thus making direct anterior removal very difficult [1]. However, by now, the overall status of complications in surgery of cervical OPLL is not clear. The incidence of complications for various approaches (anterior or posterior) for OPLL has been reported but not compared.
A better understanding of complications in surgical treatment of cervical OPLL will aid when counseling patients, choosing an operative intervention, and improving surgical outcomes. Therefore, this systematic review was performed to examine the studies with special reference to surgical complications of cervical OPLL, summarize its incidence, and evaluate the impact of surgical approach (anterior or posterior), year of study publication, follow-up duration, and surgical outcome on complication incidence.
Section snippets
Inclusion criteria and search strategy
For this systematic review, the articles have been selected according to the following criterias: the article specially addressing the surgical complications (including incidence, treatment, or sequel) of patients with OPLL and consisting of 10 or more cases has been included; English literatures published between 1975 and June 2010 have been included; and the articles pertaining to thoracic or lumbar OPLL have been excluded. Those with mixed data of OPLL and cervical spondylotic myelopathy or
Study details
Our query retrieved 27 studies that met our inclusion criteria (Fig. 1). All the studies are retrospective case series. The patients’ demographics of each study are summarized in Table 1 [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40]. These studies included a total of 1,558 patients. The male:female ratio ranged from approximately 1.7:1 to 23:1. The mean age of patients ranged from
Incidence of complications
The total incidence of surgical complications of cervical OPLL in the systematic review (21.8%) is relatively higher than that reported in other previous reviews, including several large cohort studies on surgery for principal cervical diseases (5–19%) [6], [7], [8], [9], [10], [11]. It is similar with other reviews that the incidence of complications reported in the included studies varies widely, by which it is difficult to deduce which are best or worst studies. Previous studies reported
Conclusion
The overall incidence of surgical complications of cervical OPLL was 21.8%. Cerebrospinal fluid leakage, neurologic deficit, axial pain, and implant complications were relatively common complications after surgery of cervical OPLL. No surgery-related death was reported. The overall morbidity of complications was not statistically different between posterior and anterior procedures and not correlated with the year of study publication, mean age of patients, postoperative recovery rate, or
Acknowledgments
The authors thank Dr Gabriel Liu for his careful editing.
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Author disclosures: HL: Nothing to disclose. LYD: Nothing to disclose.