{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:56:24Z","timestamp":1791305784577,"version":"4.3.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>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 \u201cspinal cord de-tension\u201d 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\u20139), 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.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1912076","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:36:10Z","timestamp":1791304570000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Posterior circumferential decompression for multilevel thoracic ossification of the posterior longitudinal ligament: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Lei","family":"Ren","sequence":"first","affiliation":[{"name":"Joint Sports Medicine Department, The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongju","family":"Liu","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, China-Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuiguo","family":"Sun","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Peking University Third Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieyu","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Hand, Foot and Vascular Surgery, Peking University Shenzhen Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Xu","sequence":"additional","affiliation":[{"name":"Joint Sports Medicine Department, The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]},{"name":"Department of Bone and Joint, Liwan District Orthopedic and Traumatology Hospital","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiye","family":"Ti","sequence":"additional","affiliation":[{"name":"Joint Sports Medicine Department, The Second Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"520","DOI":"10.3171\/2024.10.SPINE24941","article-title":"A novel posterior decompression technique (anterior sliding decompression osteotomy) for beak-type ossification of the posterior longitudinal ligament in the thoracic spine","volume":"42","author":"Park","year":"2025","journal-title":"J Neurosurg Spine"},{"key":"B2","doi-asserted-by":"publisher","first-page":"4852","DOI":"10.3390\/jcm11164690","article-title":"Treatment for the thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum","volume":"11","author":"Machino","year":"2022","journal-title":"J Clin Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1177\/21925682251374669","article-title":"Balancing efficacy and safety for non-ambulatory thoracic OPLL: superior mobility with circumferential decompression but higher risks\u2014a retrospective analysis","volume":"16","author":"Lei","year":"2026","journal-title":"Global Spine J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1080\/08941939.2020.1839149","article-title":"Treatment of thoracic ossification of posterior longitudinal ligament with one-stage 360 degree circumferential decompression assisted by piezosurgery","volume":"35","author":"Yang","year":"2022","journal-title":"J Invest Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s00774-019-01026-8","article-title":"Clinical characteristics of patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament","volume":"38","author":"Endo","year":"2020","journal-title":"J Bone Miner Metab"},{"key":"B6","doi-asserted-by":"publisher","first-page":"330","DOI":"10.22603\/ssrr.2021-0095","article-title":"The essence of clinical practice guidelines for ossification of spinal ligaments, 2019: 5. 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