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Case Reports
. 2025 Jun 18;16(6):107753.
doi: 10.5312/wjo.v16.i6.107753.

Thoracic anterior controllable antedisplacement fusion for thoracic ossification of the posterior longitudinal ligament: A case report

Xing-Yu Jin  1 , Hua-Zheng Wang  1 , Kai Yang  1 , Yu Bao  1 , Ye Wang  1 , Xing-Lei Ben  1 , Hai-Yan Sun  2
Affiliations
Case Reports

Thoracic anterior controllable antedisplacement fusion for thoracic ossification of the posterior longitudinal ligament: A case report

Xing-Yu Jin et al. World J Orthop. .

Abstract

Background: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is caused by the ossified posterior longitudinal ligament occupying space in the spinal canal, which causes compression of the thoracic spinal cord. Surgical treatment is difficult, risky and complicated; thus, clinical treatment is difficult at present.

Case summary: A case of severe multi-segmental T-OPLL treated with thoracic anterior controllable antedisplacement fusion (TACAF) is reported, including the surgical procedures and analysis of the clinical data. The modified-Japanese Orthopaedic Association score in this patient was 4 before surgery, and it was raised to 9 after the operation. The symptoms of spinal canal compression were subsequently relieved. Three months after surgery, digital radiography showed good healing and recovery of limb sensory function.

Conclusion: This case report suggests that TACAF is feasible for the treatment of long-segment T-OPLL, and has the advantages of low risk and reduced trauma. However, this operation still needs to be verified by clinical research with a larger sample size.

Keywords: Antedisplacement fusion; Case report; Ossification of posterior longitudinal ligament; Spinal cord decompression; Thoracic spinal canal stenosis; Vertebral advancement.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Preoperative diabetic retinopathy and computed tomography. A and B: Orthoposition and lateral position of thoracic vertebra diabetic retinopathy before operation; C: Thoracic vertebra computed tomography sagittal position before operation. It can be seen that the posterior longitudinal ligament is severely ossified and protrudes backward into the spinal canal; D: Intervertebral space of T2/3; E: Intervertebral space of T3/4; F: Intervertebral space of T4/5; G: Intervertebral space of T5/6.
Figure 2
Figure 2
Preoperative magnetic resonance. A: Magnetic resonance sagittal position of thoracic spine before operation. It can be seen that T2-6 spinal canal is obviously compressed and the signal of spinal cord changes; B: Intervertebral space of T2/3; C: Intervertebral space of T3/4; D: Intervertebral space of T4/5; E: Intervertebral space of T5/6.
Figure 3
Figure 3
Operation flow chart. A: Patient lesion segment; B: Screw was placed in the diseased segment, two proximal segments and two distal segments. At this time, the screw is not completely screwed in; C: The lamina of the diseased segment was removed, and the upper and lower intervertebral discs of the diseased segment were removed; D: Place the connecting rod and lock it, and push the diseased segment forward.
Figure 4
Figure 4
Postoperative diabetic retinopathy and computed tomography. A and B: Orthoposition and lateral position of postoperative thoracic vertebra diabetic retinopathy; C: Using computed tomography to measure Kyphosis-Line before operation; D: Measure that the vertebral body moves forward about 0.44 mm; E: Measure Kyphosis-Line after operation.
Figure 5
Figure 5
Postoperative magnetic resonance. A: Postoperative magnetic resonance sagittal position, Spinal canal and spinal cord compression relief; B: Intervertebral space of T2/3; C: Intervertebral space of T3/4; D: Intervertebral space of T4/5; E: Intervertebral space of T5/6.
Figure 6
Figure 6
Review diabetic retinopathy three months after operation. The rib osteotomy has healed. A: Diabetic retinopathy (DR) orthoposition position three months after operation; B: DR lateral position three months after operation.
See this image and copyright information in PMC

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