Novel Simultaneous Decompression Through Single-stage Mini-thoracotomy for Concurrent Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum at the Same Thoracic Level

Abstract

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

Hypertrophied posterior longitudinal ligament and ligamentum flavum causing myelopathy: a case report and literature review

“…Another case described the concomitant occurrence of symptomatic OLF in the thoracic spine and asymptomatic OPLL of the cervical spine [13]. Concurrent occurrence of OPLL and OLF in the thoracic spine leading to thoracic myelopathy is not common and few articles are published in the [14,15]. However, we could not find any reports in global literature where the simultaneous occurrence of HPLL and HLF in the thoracic spine.…”

“Cave-in” decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report

“…Although there is less risk of instability and kyphosis, we still inform the patient return visit on time. Yoon reports a case with TOPLL treated through a lateral transthoracic approach by drilling the whole rib head, part of the pedicle and upper vertebral lamina, the posterior one-third intervertebral disc, and the vertebral body (29). The excision range of bony structures is similar to ours, and there was no kyphotic change or instability in the thoracic spine after more than a year of follow-up, although instrumentation was not There was no evidence of instability or kyphosis on CT (A,B) and MRI (C,D) films 6 months after surgery and the thoracic spinal cord was completely decompressed.…”

Anterior shift of the ventral dura mater: A novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine

“…Thereafter, many spine surgeons have challenged this intractable disease with many kinds of procedures, including laminectomy with or without resection of the dentate ligaments ( 1 , 20 ), anterior decompression and fusion through a thoracotomy ( 21 , 22 ), posterior decompression with instrumented spinal fusion ( 4 , 23 ), and anterior decompression through a posterior approach, the so-called Ohtsuka procedure ( 24 ). More specific procedures include circumspinal decompression through a posterior approach with thoracotomy ( 25 ), through a single posterior approach ( 9 ) and a posterolateral approach ( 26 ), staged spinal decompression through a posterior approach ( 27 ), and single-stage mini-thoracotomy without spinal fusion ( 3 , 28 ).…”