Evidence map›Paper›PMID 42605441›Full record

ArticleSpine surgery and related research2026

Anterior versus Posterior Fusion Surgery for Cervical Ossification of the Posterior Longitudinal Ligament: A Systematic Review and Meta-Analysis.

Narihito Nagoshi, Takashi Hirai, Hiroshi Takahashi, Kanji Mori, Kanichiro Wada, Satoshi Maki, Yasushi Oshima, Go Yoshida, Shiro Imagama, Masahiko Takahata and 7 more

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Article in Spine surgery and related research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Narihito NagoshiDepartment of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Takashi HiraiGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Hiroshi TakahashiGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Kanji MoriGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Kanichiro WadaGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Satoshi MakiGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Yasushi OshimaGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Go YoshidaGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Shiro ImagamaGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Masahiko TakahataGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Hirotaka ChikudaGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Masahiro YoshidaGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Masao KodaGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Motoki IwasakiGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Yoshiharu KawaguchiGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Masashi YamazakiGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.
Toshitaka YoshiiGuideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Cervical ossification of the posterior longitudinal ligament (OPLL) often requires surgical decompression with fusion. Both anterior decompression and fusion (ADF) and posterior decompression and fusion (PDF) are used; however, comparative evidence regarding their clinical outcomes remains limited and inconsistent. This study aimed to systematically review and synthesize evidence comparing ADF and PDF in patients with cervical OPLL. Methods: A systematic search of Embase, the Cochrane Library, and MEDLINE was conducted from database inception to November 30, 2024. Randomized controlled trials and cohort studies directly comparing ADF and PDF were included. Outcomes of interest included neurological recovery based on the Japanese Orthopaedic Association score or recovery rate, complication rates, radiographic parameters, pain, reoperation, patient-reported outcome measures (PROMs), and healthcare costs. Pooled analyses were performed using weighted mean differences or odds ratios with 95% confidence intervals. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: Eleven studies met the inclusion criteria. The overall certainty of evidence was rated as very low. Pooled point estimates favored ADF for neurological recovery compared with PDF, although differences did not reach statistical significance. Similar findings were observed in subgroup analyses of patients with K-line (-) status or high canal-occupying ratios (≥50% to 60%). Perioperative complications were more frequent after ADF, whereas neurological complications occurred more often after PDF; however, neither comparison showed statistically significant differences. No significant differences were identified in pain reduction, radiographic outcomes, reoperation rates, or PROMs. One study reported higher healthcare costs in the PDF group. Substantial heterogeneity was present across most analyses. Conclusions: Current evidence does not demonstrate a clear advantage of either anterior or posterior fusion strategies for cervical OPLL. Given the substantial heterogeneity and very low certainty of evidence, differences between approaches should be interpreted with caution. Further well-designed comparative studies are required to determine the optimal fusion strategy.

Indexed as

anterior decompression and fusioncervical ossification of the posterior longitudinal ligamentposterior decompression and fusion

Identifiers

PMID42605441
PMCPMC13477749

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.