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The authors emphasize that FK-line intersecting the OPLL (FK-line [-]) is associated with more kyphosis and lower recovery ratios, while in FK-line (-) patients fusion yields greater FK-line distance increase, improved kyphosis correction, and better neurological recovery. Strengths, limitations, and clinical implications for surgical decision-making are discussed.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-commentary-on-flexion-k-line-status-predicts-surgical-strategy-in-multilevel-cervical-ossification-of-the-posterior-longitudinal-ligament-a-multicenter-comparison-of-laminoplasty-and-laminectomy-with-fusion/459877/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-commentary-on-flexion-k-line-status-predicts-surgical-strategy-in-multilevel-cervical-ossification-of-the-posterior-longitudinal-ligament-a-multicenter-comparison-of-laminoplasty-and-laminectomy-with-fusion/459877.png","ImageObject",300,407,{"name":92,"@type":93},"Adam","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What relationship does the commentary describe between FK-line status and postoperative recovery in OPLL surgery?","Question",{"text":112,"@type":113},"The commentary states that patients whose flexion K-line intersects the OPLL (FK-line [-]) show more kyphotic alignment and lower recovery ratios than those without intersection (FK-line [+]).","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which surgical approach does the commentary report as more effective for FK-line (-) patients?",{"text":117,"@type":113},"For FK-line (-) patients, laminectomy and fusion achieved greater increases in FK-line distance, better correction of kyphosis, and increased neurological recovery compared with laminoplasty.",{"name":119,"@type":110,"acceptedAnswer":120},"What are the main limitations highlighted for the multicenter retrospective study?",{"text":121,"@type":113},"The commentary notes selection bias risk due to the retrospective design and points out that the multicenter nature involved only three centers; it also mentions that the negative impact of multilevel fusion may not be fully captured within the 2-year follow-up.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459877,1790757153,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},1374404737137,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Neurospine 2025;22(4):951-952. [https://doi.org/10.14245/ns.2551840.920](https://doi.org/10.14245/ns.2551840.920)  \nCommentary  \nCorresponding Author  \nJohn H. Chi  \n [https://orcid.org/0000-0002-4694-6542](https://orcid.org/0000-0002-4694-6542)  \nDepartment of Neurosurgery, Brigham and Women’s Hospital/MGB, Harvard Medical School, 75 Francis St., Boston, MA, USA [Email: jchi@bwh.harvard.edu](Email: jchi@bwh.harvard.edu)  \nSee the article “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion” via [https://doi](https://doi). org/10.14245/ns.2551108.554.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://creativecom](https://creativecom)[mons.org/licenses/by-nc/4.0/](mons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.  \nCopyright © 2025 by the Korean Spinal Neurosurgery Society  \nNeurospine  \npISSN 2586-6583 eISSN 2586-6591  \nA Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion”  \nJohn H. Chi  \nDepartment of Neurosurgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA  \nOssification of the posterior longitudinal ligament (OPLL) is a frequently encountered condition with controversial treatment options including anterior and posterior surgical approaches both with its own advantages and disadvantages. OPLL causes spinal cord compression that then results in cervical myelopathy leading to neurologic deficits. The calcified ligament that is the hallmark of OPLL is unlike a typical disc osteophyte and can be very adherent or even incorporated into the dura, thereby making decompression more challenging and higher risk. The decision between whether anterior, posterior or combination approaches is best for OPLL depends on what clinical outcome to prioritize while still minimizing complications and adverse events.  \nThe authors in this article1 present a multicenter, retrospective series of 349 patients undergoing posterior surgery for OPLL with minimum 2-year follow-up and report clinical outcomes in the context offlexion K-line status. The posterior surgery was either laminoplasty or laminectomy with fusion. The authors report that patients with flexion K-line that intersects with the OPLL (FK-line [-]) had more kyphotic alignment and lower recovery ratios compared to patients with flexion K-line that did not intersect with the OPLL (FKline [+]). Additionally, in FK-line (-) patients, laminectomy and fusion achieved greater increase in FK-line distance, better correction of kyphosis, and increased neurological recovery compared to laminoplasty.  \nThe strengths ofthis study include the multicenter design and the relatively high number of patients for the condition treated. The focus on just posterior surgery also allows for amore homogeneous surgical comparison on similar surgeries and having a single radiographic measurement in the flexion K-line simplifies the analysis. However, the multicenter design only included 3 centers and being retrospective, there is always the potential for selection bias in deciding which surgery to perform. Additionally, the negative impact of multilevel fusion is not really captured or described in this manuscript and adjacent segment fail  \n[www.e-neurospine.org](www.e-neurospine.org) 951  \nures may occur later than the 2-year follow-up included here.  \nThe overall results of this study support the well-recognized notion that appropriate cervical lordosis is critical for success in cervical surgery and that laminoplasty is best in patients with preserved cervical lordosis. Though K-line m","cbCaidnJFqGuMZxf","https://ap.wps.com/l/cbCaidnJFqGuMZxf","pdf",159394,"English","# Commentary overview\n## Study design and patient outcomes by FK-line status\n## Comparative effectiveness of laminoplasty vs fusion\n## Strengths, limitations, and clinical implications","[{\"question\":\"What relationship does the commentary describe between FK-line status and postoperative recovery in OPLL surgery?\",\"answer\":\"The commentary states that patients whose flexion K-line intersects the OPLL (FK-line [-]) show more kyphotic alignment and lower recovery ratios than those without intersection (FK-line [+]).\"},{\"question\":\"Which surgical approach does the commentary report as more effective for FK-line (-) patients?\",\"answer\":\"For FK-line (-) patients, laminectomy and fusion achieved greater increases in FK-line distance, better correction of kyphosis, and increased neurological recovery compared with laminoplasty.\"},{\"question\":\"What are the main limitations highlighted for the multicenter retrospective study?\",\"answer\":\"The commentary notes selection bias risk due to the retrospective design and points out that the multicenter nature involved only three centers; it also mentions that the negative impact of multilevel fusion may not be fully captured within the 2-year follow-up.\"}]","A Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion” | PDF"]