Objective To evaluate the clinical efficacy of microscope-assisted anterior cervical surgery in patients with ossification of the cervical posterior longitudinal ligament (OPLL) complicated by spinal cord injury.

Methods A total of 72 patients with OPLL who underwent anterior cervical surgery at Zhongshan Hospital Affiliated to Dalian University from January 2019 to January 2024 were retrospectively included. According to the surgical approach used, they were divided into a microscope-assisted group (n = 38) and a conventional group (n = 34). Perioperative indicators, complications, and preoperative and 12-month postoperative visual analogue scale (VAS) score, Frankel grade, Japanese Orthopaedic Association (JOA) score, and JOA improvement rate were compared between the two groups.

Results The two groups were comparable in baseline characteristics, such as age, sex, type of ligament ossification, and number of involved vertebral segments (all P ＞ 0.05). Compared with the conventional group, the microscope-assisted group showed significant advantages in shorter operative time, less intraoperative blood loss, lower drainage volume, and shorter hospital stay (all P ＜ 0.05). At 12 months after surgery, VAS score, Frankel grade, and JOA score were all improved in both groups compared with those before surgery (all P ＜ 0.001). The microscope-assisted group had better VAS score, Frankel grade, JOA score, and JOA improvement rate than the conventional group (all P ＜ 0.05), and a lower incidence of complications (2.6% vs. 11.8%).

Conclusions Microscope-assisted anterior cervical surgery has advantages in the treatment of OPLL complicated by spinal cord injury. It can reduce surgical trauma, decrease the incidence of complications, and improve surgical efficacy.