Study Design. Technical case report. Objective. To describe a novel technique of decompression through single-stage mini-thoracotomy for removing concurrent ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) at the same thoracic level simultaneously. Summary of Background Data. Concurrent OPLL and OLF at the same thoracic level is not common. Because these conditions lead to severe thoracic myelopathy, however, they require surgical decompression. To date, several cases with concurrent OPLL and OLF at the same thoracic level and surgical methods to treat these conditions have been described. However, no consensus on the surgical methods for the treatment these conditions has been established and these surgical methods have been also reported to be linked with the incidence of complication like neurological deterioration and the requirement of bone grafting and instrumentation. Methods. Three consecutive patients who presented with thoracic myelopathy caused by concurrent OPLL and OLF at the same thoracic level were treated by our novel surgical technique of decompression through single-stage mini-thoracotomy. Results. Simultaneous complete removal of OPLL and OLF through single-stage mini-thoracotomy was performed successfully in the three patients. All patients’ preoperative symptoms gradually improved during the follow-up period, and no additional complications were associated with removal of OLF through thoracotomy. And there was no kyphotic change or instability in the thoracic spine after more than a year of follow-up although both bone grafting and instrumentation were not performed. Conclusion. This novel surgical technique is considered to be able to be a safe and effective alternative to the conventional treatment of selective cases of thoracic myelopathy caused by concurrent OPLL and OLF at the same thoracic level. Level of Evidence: 4

Objective: Anterior lumbar interbody fusion (ALIF) has advantages over posterior lumbar interbody fusion or transforaminal lumbar interbody fusion techniques in that it minimizes damage to the anatomical structure of the posterior spinal segment and enables indirect decompression of the foramen by insertion of a tall cage. However, the predominant abdominal scar tissue reduces patients' satisfaction after ALIF. Herein, we describe the technique of transumbilical lumbar interbody fusion (TULIF) and its preliminary results in a case series. Methods: A retrospective review of 154 consecutive patients who underwent TULIF between the L2-3 and L4-5 levels was performed. After preoperatively selecting patients by evaluating the location of the umbilicus and vessel anatomy, a vertical skin incision was made on the umbilicus to minimize the abdominal scar tissue. Results: There were 120 single-level (110 L4-5 and 10 L3-4), 31 two-level, and 3 three-level surgeries. All patients were very satisfied with their postoperative abdominal scars, which were noticeably faint compared to those after conventional ALIF. Conclusion: TULIF is a feasible, minimally invasive surgical option that can achieve both the treatment of degenerative spinal disease and satisfactory cosmesis. Although it is technically demanding, patients obtain sufficient benefits.

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