INTRDUCTION: The anterior approach to cervical ossification of posterior longitudinal ligament (OPLL) excision may improve long-term neurofunctional recovery by providing direct spinal cord decompression. The objective was to compare the clinical outcomes and complications between accurate anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) vs. piecemeal resection (ACOP). METHODS: A total 189 OPLL patients who underwent anterior cervical surgery were included in this study. The mean age of participants was 54.85 years (65 females): 105 patients (39 females, mean age was 55.69 years) underwent ACOE, and 84 patients (26 females, mean age was 53.80 years) underwent ACOP. And a total of 70 patients with a canal occupying ratio (COR) ≥ 50% were included in the study. Data were stratified by COR with 50%. Clinical outcomes were compared between the ACOE and ACOP groups with at least 27 months follow-up. RESULTS: The mean final follow-up JOA score was higher in ACOE group. The JOA recovery rate of patients with COR ≥ 50% was higher in ACOE group. The mean operative time and intraoperative blood loss both were lower in ACOE group. However, postoperative complications were not significantly different between the two groups. CONCLUSIONS: This study demonstrated that the ACOE technique gained higher JOA recovery rates and better neurological recovery than ACOP for the OPLL patients with COR≥50%. In addition, ACOE offered a shorter operative time and less intraoperative blood loss as compared with ACOP. Therefore, the postoperative complications were not more common between two groups.
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