A Modified Decompression Surgery for Thoracic Myelopathy Caused by Ossification of Posterior Longitudinal Ligament

Abstract

Case report and review. We report a case with severe thoracic myelopathy because of ossification of the posterior longitudinal ligament (OPLL) of the spine, in which the OPLL was removed via a modified decompression approach, with sufficient decompression of the spinal cord and a satisfactory outcome was achieved. Many different decompressive surgeries may be applied for thoracic myelopathy caused by OPLL. However, there are variations among patients with thoracic myelopathy because of OPLL, and the possibility of postoperative paralysis remains a major risk, and to date, the effective treatment option for thoracic myelopathy caused by OPLL is still controversial. The patient was a 60-year-old woman with isolated OPLL at T10/T11 with anteriorly compression in the spinal cord. Posterior decompression by laminectomy and anterior decompression by extirpation of the OPLL were performed by a posterior-lateral approach. First, spinal cord retrocession was achieved to relieve the compression of OPLL by posterior decompression. Second, the posterior 2/3 of involved vertebral bodies and the T10/T11 intervertebral disc were resected with the anterior-lateral approach. Then, the OPLL was extirpated from the anterior direction in order to relieve the spinal cord compression completely, and the resected ribs were used for the anterior column reconstruction. Finally, a titanium device was secured over the area of surgery to stabilize the spinal column. Complete removal of the ossification was achieved in the present patient. Satisfactory surgical outcome of this patient was confirmed by a follow-up of 3 years after operation. The present case suggests that posterior decompression, anterior extirpation of OPLL, and interbody fusion with spinal instrumentation only via a modified posterior-lateral approach is a novel, safe, and effective procedure for surgical treatment of thoracic OPLL.