Comparative Therapeutic Effectiveness and Complications of Anterior vs Posterior Surgical Approach in non-Ossification of the Posterior Longitudinal Ligament (OPLL) Degenerative Cervical Myelopathy: A Systematic Review and Meta-analysis.

Objective

To compare the anterior and posterior surgical approaches for management of degenerative cervical myelopathy.

Methods

We systematically searched MEDLINE, EMBASE, Scopus, and Web of Science following a PRISMA protocol. Random-effects meta-analyses were performed using Hartung-Knapp confidence intervals. Outcomes were pooled as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). Functional outcomes were assessed against minimal clinically important differences (MCID), and certainty of evidence using GRADE.

Results

Fifty-two studies including 22,562 anterior and 19,762 posterior procedures were analysed. Compared with posterior surgery, anterior surgery was associated with lower odds of C5 palsy (OR=0.35, 95% CI: 0.18-0.70 for ≥3 levels), neck pain (OR=0.31, 95% CI: 0.20-0.49), infection (OR=0.28, 95% CI: 0.16-0.50), and thrombotic complications (OR=0.51, 95% CI: 0.31-0.86), but higher odds of dysphagia (OR=3.80, 95% CI: 2.45-5.90). Anterior surgery provided greater C2-C7 Cobb angle lordotic correction overall (MD=5.92°, 95% CI: 3.32-8.52) and for ≥3 levels (MD=6.51°, 95% CI: 2.08-10.93), with lower blood loss (MD=-91 mL, 95% CI: -167 to -15). Differences in functional outcomes were below accepted MCIDs: Neck Disability Index differed by -2.85 points (95% CI: -5.54 to -0.15; MCID=7.5), while mJOA differences were -0.13 (95% CI: -0.59 to 0.33) at <6 months, 0.36 (95% CI: -0.16 to 0.88) at 6-12 months, and 0.23 (95% CI: -0.03 to 0.48) beyond 12 months (MCID=2).

Conclusion

Anterior and posterior approaches have distinct risk and radiographic profiles, without clinically important differences in functional outcomes. Low-certainty evidence limits conclusions regarding superiority.