• Yu Chen, Jingchuan Sun, Xiaoqiu Yuan, Yongfei Guo, Haisong Yang, Deyu Chen, and Jiangang Shi.
• Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
• Spine. 2020 Aug 15; 45 (16): 1091-1101.

Study DesignA prospective, randomized, controlled study.ObjectiveTo compare anterior controllable antidisplacement and fusion (ACAF) with laminoplasty in the treatment of multilevel ossification of the posterior longitudinal ligament (OPLL), and evaluate the efficacy and safety of this procedure.Summary Of Background DataThe optimal approach for the treatment of OPLL still remains controversial. Both anterior and posterior approaches have their advantages and disadvantages.MethodsBetween September 2016 and April 2018, a total of 80 patients with multilevel OPLL were randomized in a 1:1 ratio to ACAF group and laminoplasty group. All patients were followed up at least 1 year. Clinical and radiological results were compared between ACAF group and laminoplasty group.ResultsACAF took a longer operation time. C5 palsy and axial pain occurred more commonly in laminoplasty group, whereas dysphagia and hoarseness appeared easily in ACAF group. At 1-year follow-up, the final Japanese Orthopedic Association (JOA) score and recovery rate were significant higher in ACAF group than those in laminoplasty group, when occupying rate (OR) was not less than 60%, or K-line was negative. ACAF was also good at preservation of cervical lordosis and sagittal balance, but range of movement of cervical spine in both groups decreased significantly.ConclusionGenerally speaking, ACAF is a safe and effective alternative for multilevel OPLL. Compared with laminoplasty, ACAF is more effective in the cases when OR is not less than 60%, or K-line is negative.Level Of Evidence2.

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