Posterior circumferential decompression for multilevel thoracic ossification of the posterior longitudinal ligament: a case report and literature review.
5 affiliations
- 1Joint Sports Medicine Department, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- 2Neurosurgery Department, China-Japan Friendship Hospital, Beijing, China.
- 3Orthopedic Department, Peking University Third Hospital, Beijing, China.
- 4Department of Hand, Foot and Vascular Surgery, Peking University Shenzhen Hospital, Shenzhen, China.
- 5Department of Bone and Joint, Liwan District Orthopedic and Traumatology Hospital, Guangzhou, China.
Abstract
Multilevel thoracic ossification of the posterior longitudinal ligament (T-OPLL), especially when it involves more than five consecutive vertebrae, remains surgically challenging. In recent years, a strategy focused on "spinal cord de-tension" has been proposed for such extensive involvements. This report describes a 52-year-old woman who presented with progressive thoracic myelopathy due to continuous OPLL from T3 to T10, causing severe canal stenosis. The surgical approach included a posterior laminectomy from T4 to T10, circumferential decompression at the most compressed level (T8-9), and long-segment instrumentation from T3 to T11. A postoperative cerebrospinal fluid leak was suspected but managed conservatively with controlled drainage and bed rest. By the 12-month follow-up, the patient's neurological status had improved markedly: her modified Japanese Orthopaedic Association (mJOA) score rose from 5 to 10, corresponding to a Hirabayashi recovery rate of 83.3%. Radiographs showed adequate decompression, solid fusion, and no implant failure. Taken together, for symptomatic, ultra-long segment T-OPLL, posterior circumferential decompression combined with long-segment fusion under the spinal cord de-tension principle appears to be highly effective. Spinal shortening achieved through parallel osteotomy and compression provides indirect longitudinal de-tension, complementing direct ventral decompression while maintaining stability. Careful surgical technique and systematic management of complications like cerebrospinal fluid leakage remain essential for a good outcome. This approach offers a favorable risk-benefit balance in these complex cases.
Related
- Clinical Outcomes and Feasibility of Unilateral Biportal Endoscopic Decompression for Thoracic Ossification of the Ligamentum Flavum: A Retrospective Single-Center Study
- Postoperative ossification progression after decompression for thoracic ossification of the ligamentum flavum: associated factors identified by serial CT analysis.
- Neurological and Functional Outcomes After Decompression With or Without Fusion for Thoracic Ossification of the Ligamentum Flavum: A Systematic Review and Evidence Synthesis.
- Comparative Analysis between Vertebral Body Sliding Osteotomy and Anterior Cervical Corpectomy with Fusion for Cervical Spinal Ossification of Posterior Longitudinal Ligament
- Recurrent postoperative symptomatic epidural hematoma after thoracic decompression surgery: a case report and literature review
BibTeX
@article{ren2026posterior,
title = {{Posterior circumferential decompression for multilevel thoracic ossification of the posterior longitudinal ligament: a case report and literature review.}},
author = {Lei Ren and Hongju Liu and Chuiguo Sun and Jieyu Liang and Chao Xu and Weiye Ti},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1912076},
url = {https://europepmc.org/article/MED/42904212},
note = {CC BY},
}
RIS
TY - JOUR
TI - Posterior circumferential decompression for multilevel thoracic ossification of the posterior longitudinal ligament: a case report and literature review.
AU - Lei Ren
AU - Hongju Liu
AU - Chuiguo Sun
AU - Jieyu Liang
AU - Chao Xu
AU - Weiye Ti
PY - 2026
DA - 2026/10/06
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1912076
UR - https://europepmc.org/article/MED/42904212
AB - Multilevel thoracic ossification of the posterior longitudinal ligament (T-OPLL), especially when it involves more than five consecutive vertebrae, remains surgically challenging. In recent years, a strategy focused on "spinal cord de-tension" has been proposed for such extensive involvements. This report describes a 52-year-old woman who presented with progressive thoracic myelopathy due to continuous OPLL from T3 to T10, causing severe canal stenosis. The surgical approach included a posterior laminectomy from T4 to T10, circumferential decompression at the most compressed level (T8-9), and long-segment instrumentation from T3 to T11. A postoperative cerebrospinal fluid leak was suspected but managed conservatively with controlled drainage and bed rest. By the 12-month follow-up, the patient's neurological status had improved markedly: her modified Japanese Orthopaedic Association (mJOA) score rose from 5 to 10, corresponding to a Hirabayashi recovery rate of 83.3%. Radiographs showed adequate decompression, solid fusion, and no implant failure. Taken together, for symptomatic, ultra-long segment T-OPLL, posterior circumferential decompression combined with long-segment fusion under the spinal cord de-tension principle appears to be highly effective. Spinal shortening achieved through parallel osteotomy and compression provides indirect longitudinal de-tension, complementing direct ventral decompression while maintaining stability. Careful surgical technique and systematic management of complications like cerebrospinal fluid leakage remain essential for a good outcome. This approach offers a favorable risk-benefit balance in these complex cases.
SN - 2296-875X
ER -