Objectives:To evaluate the efficacies of laminoplasty(LP)and laminectomy and fusion(LF)in the treatment of multi-level ossification of the posterior longitudinal ligament(OPLL)in the cervical spine through meta-analysis.Methods:The databases of CNKI,Wanfang,Pubmed,Cochrane Library,EMBASE were searched by computer from their inceptions to June 2023 and the published clinical studies comparing LP and LF in the treatment of multi-level OPLL in the cervical spine were included.Cochrane risk bias assess-ment tool and Newcastle-Ottawa scale(NOS)were used to evaluate the quality of the included studies.Rele-vant data including operation time,intraoperative blood loss,the improvement rate of Japanese Orthopaedic Association(JOA)score,the change value of visual analogue scale(VAS)score,neck disability index(NDI),cer-vical curvature index(CCI),sagittal vertical axis(SVA)and cervical range of motion(CROM)at the final fol-low-up,the postoperative complication rate and OPLL progression rate were extracted and sorted.Then the meta-analysis was conducted by RevMan 5.4 and StataSE 16.0 softwares.Results:12 literatures(3 randomized controlled studies and 9 cohort studies)were ultimately included,involving a total sample size of 1496 cases,containing 839 cases in the LP group and 657 cases in the LF group.The results of meta-analysis were as follows:the LP group was better than LF group with significant differences in operation time[WMD=-28.01,95％CI(-36.25,-19.77),P＜0.00001],intraoperative blood loss[WMD=-115.09,95％CI(-197.91,-32.27),P=0.006],the change value of CROM[WMD=-7.83,95％CI(-8.10,-7.55),P＜0.00001]compared with those before surgery at final follow-up,the incidence of postoperative C5 nerve root paralysis[OR=0.32,95％CI(0.21,0.50),P＜0.00001]and axial symptoms[OR=0.44,95％CI(0.28,0.71),P=0.0006].The LF group was better than the LP group with significant differences in the change value of the CCI[WMD=-0.75,95％CI(-0.92,-0.58),P＜0.00001]and SVA[WMD=5.49,95％CI(5.30,5.68),P＜0.00001]compared with those before surgery at final follow-up,and the postoperative OPLL progression rate[OR=1.76,95％CI(1.26,2.46),P=0.0009].There were no significant differences between the two groups in the improvement rate of JOA score[WMD=-1.24,95％CI(-4.02,1.54),P=0.38],the change value of VAS[WMD=0.03,95％CI(-0.43,0.49),P=0.89]and NDI[WMD=0.54,95％CI(-0.07,1.14),P=0.08]compared with those before surgery at final follow-up,the incidence of postoperative cerebrospinal fluid leakage[OR=0.58,95％CI(0.24,1.39),P=0.22],incision infection[OR=0.71,95％CI(0.32,1.57),P=0.39]and epidural hematoma[OR=0.37,95％CI(0.06,2.16),P=0.27].Conclusions:Both LF and LP can effectively treat multi-level OPLL in the cervical spine and improve the neurological function of patients.Compared to LF,LP causes less surgical damage,preserves more cervical mobility and additionally,has a lower incidence of the postoperative C5 nerve root paralysis and axial symptoms.In comparison,LF can better maintain the curvature and stability of the cervical spine and delay the progression of ossification.

Objectives:To evaluate the efficacies of laminoplasty(LP)and laminectomy and fusion(LF)in the treatment of multi-level ossification of the posterior longitudinal ligament(OPLL)in the cervical spine through meta-analysis.Methods:The databases of CNKI,Wanfang,Pubmed,Cochrane Library,EMBASE were searched by computer from their inceptions to June 2023 and the published clinical studies comparing LP and LF in the treatment of multi-level OPLL in the cervical spine were included.Cochrane risk bias assess-ment tool and Newcastle-Ottawa scale(NOS)were used to evaluate the quality of the included studies.Rele-vant data including operation time,intraoperative blood loss,the improvement rate of Japanese Orthopaedic Association(JOA)score,the change value of visual analogue scale(VAS)score,neck disability index(NDI),cer-vical curvature index(CCI),sagittal vertical axis(SVA)and cervical range of motion(CROM)at the final fol-low-up,the postoperative complication rate and OPLL progression rate were extracted and sorted.Then the meta-analysis was conducted by RevMan 5.4 and StataSE 16.0 softwares.Results:12 literatures(3 randomized controlled studies and 9 cohort studies)were ultimately included,involving a total sample size of 1496 cases,containing 839 cases in the LP group and 657 cases in the LF group.The results of meta-analysis were as follows:the LP group was better than LF group with significant differences in operation time[WMD=-28.01,95％CI(-36.25,-19.77),P＜0.00001],intraoperative blood loss[WMD=-115.09,95％CI(-197.91,-32.27),P=0.006],the change value of CROM[WMD=-7.83,95％CI(-8.10,-7.55),P＜0.00001]compared with those before surgery at final follow-up,the incidence of postoperative C5 nerve root paralysis[OR=0.32,95％CI(0.21,0.50),P＜0.00001]and axial symptoms[OR=0.44,95％CI(0.28,0.71),P=0.0006].The LF group was better than the LP group with significant differences in the change value of the CCI[WMD=-0.75,95％CI(-0.92,-0.58),P＜0.00001]and SVA[WMD=5.49,95％CI(5.30,5.68),P＜0.00001]compared with those before surgery at final follow-up,and the postoperative OPLL progression rate[OR=1.76,95％CI(1.26,2.46),P=0.0009].There were no significant differences between the two groups in the improvement rate of JOA score[WMD=-1.24,95％CI(-4.02,1.54),P=0.38],the change value of VAS[WMD=0.03,95％CI(-0.43,0.49),P=0.89]and NDI[WMD=0.54,95％CI(-0.07,1.14),P=0.08]compared with those before surgery at final follow-up,the incidence of postoperative cerebrospinal fluid leakage[OR=0.58,95％CI(0.24,1.39),P=0.22],incision infection[OR=0.71,95％CI(0.32,1.57),P=0.39]and epidural hematoma[OR=0.37,95％CI(0.06,2.16),P=0.27].Conclusions:Both LF and LP can effectively treat multi-level OPLL in the cervical spine and improve the neurological function of patients.Compared to LF,LP causes less surgical damage,preserves more cervical mobility and additionally,has a lower incidence of the postoperative C5 nerve root paralysis and axial symptoms.In comparison,LF can better maintain the curvature and stability of the cervical spine and delay the progression of ossification.

AIM: To investigate the relationship between objective ocular torsion and near stereopsis in patients with primary superior oblique overaction(PSOOA).METHODS: Retrospective study. A total of 59 strabismus patients with PSOOA who underwent strabismus surgery at Renmin Hospital of Wuhan University between January 2019 and November 2023 were collected. Based on the collected fundus photographs and the position of the fovea relative to the horizontal line through the optic disc, the eyes were categorized as incyclotorsion, excyclotorsion, or no cyclotorsion. Additionally, the fovea-disc angle(FDA)and the relationship between objective ocular torsion status, FDA, and near stereopsis function in the patients were further measured and analyzed.RESULTS: Totally 59 patients(92 eyes)showed superior oblique overaction. There were no cases of excyclotorsion, 32 cases with no cyclotorsion, and 27 cases with incyclotorsion. The total binocular FDA was significantly smaller in the no-cyclotorsion group compared with the incyclotorsion group(2.83°±2.89° vs 16.12°±5.74°, P<0.001). The preservation rates of near stereopsis were 66% and 15% in the no-cyclotorsion and incyclotorsion groups, respectively, with a significant statistical difference(P<0.001), and the preservation rates of fine near stereopsis were 38% and 11% in the no-cyclotorsion and incyclotorsion groups, respectively, with a significant statistical difference(P=0.02). Among all patients, near stereopsis was correlated with total binocular FDA(r=-0.526, P<0.001), with the strongest correlation observed with the FDA of the incyclotorsion(r=-0.546, P<0.001). In the incyclotorsion group, there was no correlation between near stereopsis and total binocular FDA(r=-0.366, P=0.060), with a negative correlation between near stereopsis and the FDA of both the incyclotorsion and the overaction(r=-0.424, P=0.028; r=-0.485, P=0.010). In the no-cyclotorsion group, near stereopsis was not correlated with total binocular FDA, incyclotorsion FDA, or overaction FDA.CONCLUSION:PSOOA patients with incyclotorsion have a lower preservation rate of near stereopsis than those without cyclotorsion. Near stereopsis function of patients with PSOOA is negatively correlated with total binocular FDA, especially the greater the FDA of the incyclotorsion and overaction, the worse the near-stereoscopic function.