الفهرس 
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Abstract
Background: Cervical myelopathy is a dysfunction of the spinal cord. It is often caused by a narrowing of the cervical spinal canal. Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly. Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM).The pathogenesis of OPLL is poorly understood. Some have suggested it as a variant of diffuse idiopathic skeletal hyperostosis (DISH).
Purpose: The purpose of the study is to perform a systematic review and meta-analysis to evaluate the Clinical results of anterior and posterior approaches for the treatment of cervical compressive myelopathy Due to cervical ossification of the posterior longitudinal ligament (OPLL).
Methods: Randomized clinical trials, prospective cohort, retrospective observational cohort, and case-control Studies that compare the surgical outcome of an anterior versus a posterior approach for cervical myelopathy due to OPLL from January 2006 to October 2021. Databases (PubMed, EMBASE, Cochrane library). A total of 12 studies (1070patients) were included in this systematic review and meta-analysis.
Results: indicated that no statistically significant differences between the anterior group and posterior group in terms of preoperative mJOA score [P =0.23, SMD = 0.9; heterogeneity: (P = 0.85); I2 = 18%, while the postoperative JOA score was significantly higher in the anterior surgery group compared with the posterior surgery group [P 0.004, SMD = 0.67; heterogeneity: P <0.001; I2 = 82%. The recovery rate was significantly higher in the anterior surgery group compared with the posterior surgery group of patients with canal-occupying ratio < 50%- ≥ 60% [P <0.01, SMD = 0, 43; heterogeneity: (P < 0.57); I 2 = 91%].
The overall recovery rate (regardless the canal occupying ratio) was significantly higher in the anterior surgery group compared with the posterior surgery group [P < 0.01 SMD = 0.84.
It also revealed that the postoperative complication rate [P < 0.01 OR = 1.88, operation time [P < 0.01 SMD = 1.52, intra operative blood loss [P = 0.04 SMD = 0.74 are higher in the anterior group.
Conclusion: Based on the results of this meta-analysis, anterior approach surgery was associated with better overall (Regardless of the canal-occupying ratio) postoperative neural function than posterior approach in the treatment of cervical compressive myelopathy due to OPLL. We thought anterior approach especially preferable to patients with canal-occupying ratio > 50%-60%, although it leads to a higher surgical trauma and incidence of surgery-related complications. Posterior approach surgery was relatively safer with lower surgical trauma and incidence of complications. We also suggest posterior approach for patients with canal-occupying ratio < 50%e60%.