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Dynamic K-Line Status and Surgical Outcomes in Multilevel Cervical OPLL: A Multicenter Comparative Study.

Jun Jae Shin1, Sun Joon Yoo1, Se Jun Park1

  • 1Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea.

Journal of Clinical Medicine
|January 28, 2026
PubMed
Summary
This summary is machine-generated.

Dynamic K-line status predicts recovery in cervical ossification of the posterior longitudinal ligament (OPLL). Anterior cervical discectomy and fusion (ACDF) is most effective, while laminectomy with fusion (LF) is preferred over laminoplasty (LP) for certain K-line statuses.

Keywords:
anterior cervical discectomy and fusioncervical myelopathycervical vertebraedynamic K-linelaminectomylaminectomy with fusionossification of posterior longitudinal ligament (OPLL)

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spinal Surgery

Background:

  • Multilevel cervical ossification of the posterior longitudinal ligament (OPLL) presents complex surgical challenges.
  • Dynamic K-line status is a crucial factor influencing surgical outcomes in cervical OPLL.
  • Predicting neurological recovery is essential for optimizing treatment strategies.

Purpose of the Study:

  • To evaluate clinical and radiological outcomes of surgical interventions for cervical OPLL stratified by dynamic K-line status.
  • To identify predictors of neurological recovery in patients with multilevel cervical OPLL.
  • To compare the efficacy of anterior cervical discectomy and fusion (ACDF), laminoplasty (LP), and laminectomy with fusion (LF).

Main Methods:

  • Analysis of 535 patients with multilevel cervical OPLL undergoing ACDF, LP, or LF with ≥24 months follow-up.
  • Classification into three groups based on dynamic K-line status (neutral and flexion).
  • Multivariate regression and inverse probability of treatment weighting (IPTW) analysis to identify predictors and reduce bias.

Main Results:

  • Progressive dynamic K-line negativity correlated with cervical kyphosis, higher canal occupation, and poorer recovery.
  • ACDF demonstrated superior adjusted neurological recovery across all K-line subgroups after IPTW.
  • LF showed better recovery than LP in patients with negative neutral or flexion K-lines; larger preoperative and postoperative FK-line distance increases predicted better outcomes.

Conclusions:

  • Dynamic K-line stratification is a valuable prognostic tool for multilevel cervical OPLL.
  • ACDF is the most effective surgical option regardless of K-line status.
  • LF is recommended over LP for patients with latent or fixed negative FK-line status to enhance neurological recovery.