{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T19:24:54Z","timestamp":1793820294311,"version":"4.6.1"},"reference-count":50,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Orthop Surg (Hong Kong)"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Network Meta-Analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To comprehensively compare the clinical efficacy and safety of anterior controllable antedisplacement and fusion (ACAF), anterior cervical corpectomy and fusion (ACCF), and laminoplasty (LP) for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Cochrane Library, Embase, and Web of Science were systematically searched (inception to April 1, 2025) for clinical studies comparing at least two of ACAF, ACCF, or LP for multilevel (\u22652 segments) cervical OPLL. Data on surgical parameters, neurological function (Japanese Orthopaedic Association [JOA] score, JOA recovery rate, Visual Analog Scale [VAS]), biomechanics (cervical curvature, Cobb angle, Range of Motion [ROM], Neck Disability Index [NDI]), and complications were extracted. A frequentist network meta-analysis using a multivariate random-effects model was performed. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty-one non-randomized studies involving 2616 patients were included (ACAF: 585; ACCF: 875; LP: 1156). NMA showed ACAF and ACCF achieved significantly better postoperative JOA scores and recovery rates than LP (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). ACAF showed the highest probability of being the most effective treatment for postoperative VAS score (vs ACCF &amp; LP,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05) and maintenance of cervical curvature\/Cobb angle (vs ACCF &amp; LP,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). LP had the shortest operative time (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). Regarding safety, ACAF was associated with the lowest probability of total complications (SUCRA 99.7%), with significantly lower risks of cerebrospinal fluid (CSF) leakage versus ACCF (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05), and C5 palsy and axial pain versus LP (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). LP had the lowest risk of dysphagia (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). Subgroup analysis suggested ACAF\u2019s benefits, particularly in neurological outcome, are more pronounced in patients with severe stenosis (occupying ratio \u226560%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on current observational evidence, ACAF appears to be a promising option for multilevel cervical OPLL, particularly for patients with severe stenosis. ACCF provides effective neurological decompression but carries a higher CSF leak risk than ACAF. LP, while having shorter operative times, results in inferior neurological and biomechanical outcomes compared to anterior approaches. Surgical decisions require individualized assessment based on patient and OPLL characteristics.However, these findings should be interpreted with caution due to the predominance of non-randomized studies and potential selection bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10225536261432365","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T13:11:04Z","timestamp":1773234664000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative efficacy and safety of ACAF, ACCF, and laminoplasty for multilevel cervical OPLL: A network meta-analysis of observational studies"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2168-2165","authenticated-orcid":false,"given":"Wei","family":"Wang","sequence":"first","affiliation":[{"name":"Minda Hospital Affiliated to Hubei Minzu University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7565-8753","authenticated-orcid":false,"given":"Cheng-Hao","family":"Xiang","sequence":"additional","affiliation":[{"name":"Enshi Tujia and Miao Autonomous Prefecture"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6129-9095","authenticated-orcid":false,"given":"Dan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Centerl Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5636-7661","authenticated-orcid":false,"given":"Xian-Zao","family":"Wang","sequence":"additional","affiliation":[{"name":"Minda Hospital Affiliated to Hubei Minzu University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5844-6881","authenticated-orcid":false,"given":"Xin-Hua","family":"Xu","sequence":"additional","affiliation":[{"name":"Minda Hospital Affiliated to Hubei Minzu University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.7150\/thno.44309"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2309499020975213"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.07.138"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000001144"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-024-06172-1"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1769005"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000024900"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2023.12.126"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.11.142"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/os.12856"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.03.108"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003462"},{"issue":"11","key":"e_1_3_4_15_2","first-page":"976","article-title":"[comparison of anterior ossification complex antedisplacement fusion versus posterior laminectomy for cervical ossification of posterior longitudinal ligament]","volume":"27","author":"Wang GJ","year":"2019","unstructured":"Wang GJ, Yang C, Cui T, et al. 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