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Background <p>Unilateral open-door laminoplasty (UODL) is an established posterior surgical intervention for cervical ossification of the posterior longitudinal ligament (OPLL). However, a conclusive consensus is lacking regarding the comparative efficacy and safety of performing the open-door procedure on the contralateral versus the ipsilateral side relative to the predominant compression or symptoms.</p> Methods <p>A systematic literature search adhering to PRISMA guidelines was conducted across multiple databases (PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang) from inception to August 2025. Comparative studies evaluating contralateral versus ipsilateral UODL for cervical OPLL were included. The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale. Meta-analyses were performed using RevMan 5.4 software.</p> Results <p>Seven case–control studies met the inclusion criteria, with three included in the meta-analysis. Pooled analysis demonstrated no statistically significant differences between contralateral and ipsilateral UODL in postoperative JOA score, JOARR, VAS, NDI, operative time, blood loss, C5 palsy, or axial pain. Narrative synthesis of radiographic outcomes suggested the contralateral approach might be associated with greater postoperative spinal cord area (SCA), whereas the ipsilateral approach could induce more significant spinal cord shift. For lateral-type OPLL, the contralateral approach appeared superior in some studies.</p> Conclusions <p>Both contralateral and ipsilateral UODL are effective for managing cervical OPLL, yielding comparable improvements in neurological function, patient-reported outcomes, perioperative parameters, and complication rates. The choice of surgical approach should be individualized, considering specific OPLL morphology (with a potential preference for contralateral UODL in lateral-type OPLL) and the distinct radiographic profiles associated with each technique. Definitive superiority of one technique over the other cannot be established based on current evidence, and further large-scale, high-quality studies are warranted.</p>

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Comparative efficacy of contralateral versus ipsilateral open-door laminoplasty for cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月7日

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  • Qixuan Jiang,
  • Lei Chen,
  • Xiheng Lu,
  • Zhenyu Shi,
  • Yiqing Ling,
  • Ju Li,
  • Taotao Xu,
  • Yuanbin Zhang

摘要

Background

Unilateral open-door laminoplasty (UODL) is an established posterior surgical intervention for cervical ossification of the posterior longitudinal ligament (OPLL). However, a conclusive consensus is lacking regarding the comparative efficacy and safety of performing the open-door procedure on the contralateral versus the ipsilateral side relative to the predominant compression or symptoms.

Methods

A systematic literature search adhering to PRISMA guidelines was conducted across multiple databases (PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang) from inception to August 2025. Comparative studies evaluating contralateral versus ipsilateral UODL for cervical OPLL were included. The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale. Meta-analyses were performed using RevMan 5.4 software.

Results

Seven case–control studies met the inclusion criteria, with three included in the meta-analysis. Pooled analysis demonstrated no statistically significant differences between contralateral and ipsilateral UODL in postoperative JOA score, JOARR, VAS, NDI, operative time, blood loss, C5 palsy, or axial pain. Narrative synthesis of radiographic outcomes suggested the contralateral approach might be associated with greater postoperative spinal cord area (SCA), whereas the ipsilateral approach could induce more significant spinal cord shift. For lateral-type OPLL, the contralateral approach appeared superior in some studies.

Conclusions

Both contralateral and ipsilateral UODL are effective for managing cervical OPLL, yielding comparable improvements in neurological function, patient-reported outcomes, perioperative parameters, and complication rates. The choice of surgical approach should be individualized, considering specific OPLL morphology (with a potential preference for contralateral UODL in lateral-type OPLL) and the distinct radiographic profiles associated with each technique. Definitive superiority of one technique over the other cannot be established based on current evidence, and further large-scale, high-quality studies are warranted.