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. 2025 Jul 11.
doi: 10.1097/BSD.0000000000001876. Online ahead of print.

Comparison of Reoperation Incidence After Anterior Versus Posterior Decompression and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Analysis of a Large Claims-based Database

Soichiro Masuda  1   2 , Toshiki Fukasawa  2   3 , Bungo Otsuki  1 , Koichi Murata  1 , Takayoshi Shimizu  1 , Takashi Sono  1 , Shintaro Honda  1 , Koichiro Shima  1 , Masaki Sakamoto  1 , Shuichi Matsuda  1 , Koji Kawakami  2
Affiliations

Comparison of Reoperation Incidence After Anterior Versus Posterior Decompression and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Analysis of a Large Claims-based Database

Soichiro Masuda et al. Clin Spine Surg. .

Abstract

Study design: Cohort study.

Objective: To compare reoperation rates between anterior decompression and fusion (ADF) and posterior decompression and fusion (PDF) in patients with cervical ossification of the posterior longitudinal ligament (OPLL).

Summary of background data: Reoperation after cervical OPLL surgery is a significant concern for both patients and surgeons. It is unclear which surgical approach, ADF or PDF, is superior in terms of reoperation rates for cervical OPLL.

Methods: This study was conducted under a cohort design in patients who underwent ADF or PDF for cervical OPLL using claims-based data. Primary outcome was the incidence of reoperation during the follow-up period, and secondary outcome was total health care costs during hospitalization, and at 30 days and 1 year postoperatively. Confounding factors were adjusted using propensity score inverse probability of treatment weighting. Cumulative incidence of reoperation was calculated using the Kaplan-Meier method. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression models.

Results: The study included 251 patients (123 patients in the ADF group and 128 in the PDF group). There was no significant difference in the incidence of reoperation between the 2 groups [weighted HR 2.00 (95% CI 0.76-5.25); P=0.16]. ADF was associated with lower mean costs than PDF during hospitalization [$6416 (95% CI $4898-$7,934); P <0.001], and at 30 days [$6449 (95% CI $4942-$7956)] and 1 year postoperatively [$10,268 ($6545-$13,992); P <0.001].

Conclusions: Although reoperation rates for ADF and PDF in patients with cervical OPLL were similar, ADF was associated with lower health care costs. This study provides important information that will help surgeons make informed decisions about the choice of surgical approach for patients with cervical OPLL.

Keywords: OPLL; anterior fusion; cervical spine; database; health care cost; ossification of the posterior longitudinal ligament; posterior fusion; propensity score; reoperation; spine surgery.

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Conflict of interest statement

The authors disclose receipt of the following financial or material support for the research, authorship, and/or publication of this article: Koji Kawakami receives research funds from Eisai Co., Ltd., Kyowa Kirin Co., Ltd., OMRON Corporation, and Toppan Inc.; consulting fees from Advanced Medical Care Inc., JMDC Inc., and Shin Nippon Biomedical Laboratories Ltd.; executive compensation from Cancer Intelligence Care Systems, Inc.; and honoraria from Chugai Pharmaceutical Co., Ltd., and Pharma Business Academy. The remaining authors declare no conflict of interest.

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