Two-level Anterior Cervical Corpectomy and Fusion versus Posterior Open-door Laminoplasty for the Treatment of Cervical Ossification of Posterior Longitudinal Ligament: A Comparison of the Clinical Impact on the Occipito-Atlantoaxial Complex.

objectiveBoth two-level anterior cervical corpectomy and fusion (t-ACCF) and posterior open-door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t-ACCF and ODLP on the occipito-atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito-atlantoaxial complex in OPLL patients treated with t-ACCF and ODLP.

methodsThis was a retrospective study that included 74 patients who underwent t-ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3-month, and 1-year postoperative cervical neutral, flexion-extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2-7, C0-2, C0-1, C1-2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS.

resultsIn the ODLP group, the SCS (C2-7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0-2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t-ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t-ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0-2, C0-1, and C1-2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS.

conclusionThe loss of the SCS Cobb angle was more pronounced in ODLP relative to t-ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital-atlantoaxial complex, may leading to poorer outcomes in the long-term; of these, ODLP should receive more attention. In contrast, t-ACCF better maintains normal curvature of the SCS and occipito-atlantoaxial complex but loses more ROM.