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Objective: The purpose was to comparatively assess cervical sagittal alignment and health-related quality of life (HRQOL) outcomes, between patients who underwent cervical expansive laminoplasty (EL) and those who underwent cervical laminectomy with fusion (LF) for cervical ossification of the posterior longitudinal ligament (OPLL) in more than three levels. Methods: We retrospectively evaluated consecutive patients with cervical OPLL undergoing posterior cervical decompression from 2013-2015. We analyzed radiological measurements (C2-7 sagittal vertical axis [C2-7 SVA], C0-2 angle, C2-7 lordotic angle, T1 slope, and range of motion [ROM]) and clinical outcomes (visual analog scale, neck disability index, Short Form-36, and Japanese Orthopaedic Association scores), preoperatively and at the last follow-up. Results: There were 84 patients (63 men; 21 women). Mean follow-up period was 27.7 months (range: 24-48.8). Compared with preoperative C2-7 SVA, postoperative C2-7 SVA was significantly increased in patients in the LF (13.46 mm) and EL (2.11 mm) groups. Losses of the cervical lordotic angle and ROM were larger in cervical LF patients than in cervical EL patients. The change in the C2-7 SVA was negatively correlated with the change in the C2-7 lordotic angle and positively correlated with changes in the T1 slope and C0-2 angle. Improvements in health-related quality of life were similar between the two groups, except for patient-reported neck pain. Conclusion: Cervical EL and LF were effective surgical techniques to improve the patient-reported outcomes and HRQOL of patients with OPLL in more than three levels. Cervical EL can preserve sagittal alignment and improve clinical results and neck pain, more than cervical LF. Cervical sagittal imbalance after posterior decompression was related to axial neck pain.

Cervical Expansive Laminoplasty versus Laminectomy with Fusion for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)