Functional recovery after laminoplasty versus staged anterior–posterior fusion for multilevel cervical ossification of the posterior longitudinal ligament

Both LP and APF provided significant neurological recovery and pain relief in multilevel OPLL. APF yielded superior sagittal alignment but was associated with higher early postoperative disability, most pronounced in segmental-type OPLL. Differences diminished by the second postoperative year, suggesting patient adaptation. Surgical decision-making should consider OPLL subtype, preoperative mobility, and the trade-off between motion preservation and alignment correction.