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.

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; minimal clinically important differences=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 (minimal clinically important differences=2).