{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:38:14Z","timestamp":1788572294475,"version":"build-2803163510"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T00:00:00Z","timestamp":1615766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82072479"],"award-info":[{"award-number":["82072479"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81772381"],"award-info":[{"award-number":["81772381"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of the present paper was to evaluate the strength and the magnitude of the association between ossification of the nuchal ligament (ONL) and the risk of cervical ossification of the posterior longitudinal ligament (COPLL) and to determine whether there is a direct association or whether COPLL is a consequence of shared risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Medline, Web of Science, Cochrane Library, and Embase databases were searched for studies evaluating the association of COPLL\u2010ONL published before July 2020. Eligible studies were selected based on certain inclusion and exclusion criteria. Two investigators independently conducted the quality assessment and extracted the data, including study designs, countries, patients' age, gender, body mass index (BMI), and the risk of COPLL between individuals with and without ONL. A meta\u2010analysis of homogenous data, a sensitivity analysis, a publication bias assessment, and a subgroup analysis were performed using Stata 12.0 software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 10 cohort studies involving 8429 participants were incorporated into this analysis. Pooled results demonstrated a statistically significant association between the presence of ONL and the increased COPLL risk (odds ratio [OR] 3.84; 95% confidence interval [CI] 2.68\u20135.52, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Furthermore, subgroup analyses indicated that this association was independent of study design (6.36\u2010fold in case\u2010control studies <jats:italic>vs<\/jats:italic> 3.22\u2010fold in cross\u2010sectional studies), sex (6.33\u2010fold in male\u2013female ratio &gt;2.5 <jats:italic>vs<\/jats:italic> 2.91\u2010fold in male\u2013female ratio &lt;2.5), age (4.28\u2010fold in age \u226555\u2009years <jats:italic>vs<\/jats:italic> 3.45\u2010fold in age &lt;55\u2009years), and BMI (3.88\u2010fold in BMI\u2009\u2265\u200925 kg\/m<jats:sup>2<\/jats:sup> <jats:italic>vs<\/jats:italic> 2.43\u2010fold in BMI\u2009&lt;\u200925 kg\/m<jats:sup>2<\/jats:sup>), which also indicated that obese, older male patients with ONL had a higher risk of OPLL. Moreover, combined two articles revealed that patients with larger\u2010type ONL had a significantly higher risk of long\u2010segment COPLL compared with controls (OR 1.86; 95% CI 1.41\u20132.47, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first meta\u2010analysis to demonstrate a strong and steady association between ONL and higher risk of COPLL. This association was independent of sex, age, and BMI. Considering that ONL is generally asymptomatic and easily detectable on X\u2010ray, our findings implied that ONL might serve as an early warning sign of the onset of COPLL and provide clinicians an opportunity for early detection and early intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12938","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T07:05:26Z","timestamp":1615791926000},"page":"1055-1066","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Potential Link between Ossification of Nuchal Ligament and the Risk of Cervical Ossification of Posterior Longitudinal Ligament: Evidence and Clinical Implication from a Meta\u2010Analysis of 8429 Participants"],"prefix":"10.1111","volume":"13","author":[{"given":"Baoliang","family":"Zhang","sequence":"first","affiliation":[{"name":"Orthopaedic Department Peking University Third Hospital  Beijing 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