Int J Spine Surg. 2026 Aug 25:8939. doi: 10.14444/8939. Online ahead of print.
ABSTRACT
BACKGROUND: Cervical ossification of the posterior longitudinal ligament (OPLL) frequently progresses despite decompression surgery, leading to recurrent myelopathy. This meta-analysis aims to quantify risk factors for OPLL progression, compare surgical strategies, and determine the pooled reoperation rate due to symptomatic progression.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 26 high-quality studies comprising 1929 patients were included. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were calculated to assess risk factors, and all of the analyses were done with a random-effects model. A network meta-analysis using a random-effects model was conducted to compare surgical approaches, utilizing laminoplasty (LP) as the reference node.
RESULTS: Significant demographic risk factors for OPLL progression included younger age (SMD: -0.68, P < 0.001) and higher body mass index (SMD: 0.43, P < 0.001). Radiographically, progression was strongly driven by longer preoperative OPLL (SMD: 0.42, P = 0.003), a lower preoperative cervical range of motion (SMD: -0.30, P = 0.039), and OPLL at the C3 level (OR: 7.04, P < 0.001). Mixed-type OPLL nearly tripled the progression risk (OR: 2.94, P < 0.001), whereas segmental-type was highly protective (OR: 0.13, P < 0.001).The network meta-analysis demonstrated that motion-preserving posterior surgeries were associated with higher rates of OPLL progression. Compared with LP, anterior surgery provided the greatest reduction in progression risk (OR 0.28, P < 0.001), followed by laminectomy with fusion (OR 0.42, P < 0.001). Direct pairwise comparisons similarly confirmed that laminectomy with fusion significantly reduced the likelihood of progression compared with LP (OR 0.44, P = 0.002). Nonsurgical management was also associated with lower odds of progression; however, this finding should be interpreted with caution due to potential confounding by indication. Additionally, the pooled long-term reoperation rate due to neurological deterioration from OPLL progression was 6.1% (95% confidence interval 2.9%-10.2%) over a mean follow-up of 72.6 ± 63.7 months.
CONCLUSIONS: OPLL progression is statistically predictable, driven by younger age, higher body mass index, reduced cervical range of motion, and mixed-type morphology. Because anterior and fusion procedures were associated with lower progression rates compared with LP, these approaches should be considered in high-risk patients; however, these findings should be interpreted with caution given the heterogeneity across included studies.
CLINICAL RELEVANCE: For patients with high-risk profiles (eg, mixed-type OPLL), fusion or anterior decompression should be strongly considered over LP. When laminoplasty is used in high-risk patients, they should be advised on the necessity of long-term surveillance.
PMID:42642207 | DOI:10.14444/8939
