Comparison of anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament

Background Cervical myelopathy refers to an impairment of the spinal cord. It frequently occurs due to constriction of the cervical spinal canal. Cervical spondylotic myelopathy is the primary reason for spinal cord impairment in older individuals. Ossification of the posterior longitudinal ligament (OPLL) is rare although potentially significant factor contributing to degenerative cervical myelopathy. The etiology of OPLL is inadequately understood. Materials and methods This research aims to perform a comprehensive review and meta-analysis to assess the clinical outcomes of both anterior and posterior techniques in treating cervical compressive myelopathy caused by cervical OPLL. A comparative study examining the surgical findings of anterior and posterior approaches for cervical myelopathy owing to OPLL was conducted between January 2006 and October 2021. We reviewed online databases such as PubMed, EMBASE, and the Cochrane Library. This systematic review and meta-analysis (MA) covered 12 research articles including 1070 participants. Results Showed no statistically significant variations among the anterior group and posterior group regarding preoperative modified Japanese Orthopedic Association Score (mJOA score) (P = 0.23, SMD = 0.9; heterogeneity: P = 0.85; I-2 = 18%). However, the postoperative mJOA score was significantly greater in the anterior group contrasted to the posterior group (P = 0.004, SMD = 0.67; heterogeneity: P < 0.001; I-2 = 82%). The anterior surgery group had a substantially greater overall recovery rate than the posterior surgery group, also the recovery rate was significantly greater with the anterior technique contrasted to the posterior technique in individuals with a COR >= 50% (P value < 0.01). The study also found that the incidence of postoperative consequences in the anterior group was significantly greater (P < 0.01, OR = 1.88). Additionally, the duration of surgery in the anterior group was significantly longer (P < 0.01, SMD = 1.52), and there was a larger amount of intraoperative blood loss (P = 0.04, SMD = 0.74). Conclusion The findings of this MA indicate that anterior approach surgery is linked to superior postoperative neurological outcomes compared to the posterior method in managing cervical compressive myelopathy resulting from OPLL. We considered the anterior technique to be particularly advantageous for those with a canal-occupying ratio (COR) greater than 50%-60%, even though it results in more surgical trauma and an increased incidence of complications associated with the procedure. The posterior approach surgery demonstrated a higher level of safety with less surgical trauma and a decreased incidence of complications. We recommend the posterior approach to individuals whose COR is below 50% to 60.