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. 2025 Aug 29:21925682251374669.
doi: 10.1177/21925682251374669. Online ahead of print.

Balancing Efficacy and Safety for Non-ambulatory Thoracic OPLL: Superior Mobility with Circumferential Decompression but Higher Risks - A Retrospective Analysis

Juncai Lei  1   2   3 , Panpan Hu  1   2   3 , Xiao Liu  1   2   3 , Hua Zhou  1   2   3 , Yanchao Tang  1   2   3 , Tiantian Li  4 , Ben Wang  1   2   3 , Yan Li  1   2   3 , Fengliang Wu  1   2   3 , Liang Jiang  1   2   3 , Lei Dang  1   2   3 , Zhongjun Liu  1   2   3 , Feng Wei  1   2   3 , Xiaoguang Liu  1   2   3
Affiliations

Balancing Efficacy and Safety for Non-ambulatory Thoracic OPLL: Superior Mobility with Circumferential Decompression but Higher Risks - A Retrospective Analysis

Juncai Lei et al. Global Spine J. .

Abstract

Study DesignRetrospective cohort study.ObjectiveTo describe the clinical characteristics and surgical outcomes of non-ambulatory patients with thoracic ossification of the posterior longitudinal ligament (T-OPLL), and to identify predictors of independent walking recovery.MethodsThis retrospective study analyzed 70 non-ambulatory T-OPLL patients treated with either circumferential decompression (CD) or posterior decompression with fusion (PDF) surgery at a single center over 10 years (2012-2022). Outcomes included neurological recovery rate, independent walking recovery, and complications.ResultsOverall, 71.4% of patients regained independent walking. The CD group showed superior functional outcomes (90% vs 64% walking recovery, P = 0.030) but higher complication rates (70% vs 38% CSF leakage, P = 0.015). Shorter disease duration (P = 0.018) and lower BMI (P = 0.027) independently predicted better walking recovery.ConclusionsFor non-ambulatory T-OPLL patients, CD surgery provides better functional recovery while PDF surgery offers a safer alternative. Early surgical intervention and individualized approach selection based on disease duration and BMI are critical for optimizing outcomes.

Keywords: circumferential decompression; non-ambulatory; posterior decompression and fusion; thoracic ossification of posterior longitudinal ligament; waking recovery.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Schematic Diagram of Transpedicular Circumferential Decompression (CD) via Posterior Approach. (a) A Beak Type Thoracic Ossification of Posterior Longitudinal Ligament (T-OPLL) Lesion; (b) Laminectomy were Firstly Made with High Speed Drill or Ultrasonic Scalpel; (c) The Bilateral Residual Facets and Pedicles were Resected; (d) A “culvert” is Made by Removing the Posterior Third of the Vertebral Cancellous Bone, and the OPLL Lesion is Pushed into the “Culvert”; (e) Complete CD was Realized
Figure 2.
Figure 2.
Illustrative Case. A 59-Year-Old Female Patient was Admitted to Our Hospital with a Chief Complaint of Weakness in Both Lower Limbs for Over a Year and Non-Ambulatory Status for 1 Month. (a) Preoperative Sagittal CT Scan Showed a Beak Type Ossification of Posterior Longitudinal Ligament (OPLL) at T6-7 level; (b) Sagittal T2‐Weighted MRI Showed Significant Cord Compression at T5-8 levels; (c, d) Preoperative Axial CT and MRI Scan Showed Significant Compression by OPLL at the T7 Level, with a Spinal Canal Occupancy Rate Exceeding 50%;(e) Postoperative Sagittal CT at 3-Month Follow-Up Revealed T5-9 Laminectomy and Removal of T6-7 OPLL Lesion; (f, g) Postoperative Axial CT at 3-month Follow-Up Showed a Complete Resection of the OPLL at T6-7. One Year After Surgery, the Patient Regained Independent Walking
Figure 3.
Figure 3.
Comparison of mJOA Between PDF and CD Groups. mJOA: Modified Japanese Orthopedic Association; PDF: Posterior Decompression with Fusion; CD: Circumferential Decompression; * Represented P < 0.05 Between the Two Groups
Figure 4.
Figure 4.
The mJOA (a) and Neurological Recovery Rate (b) Changes at Different Stages. Pre op: Preoperative; mJOA: Modified Japanese Orthopedic Association; RR: Recovery Rate. (a and b) Represented mJOA Scores and Neurological Recovery Rate Changes Within Ten Years Postoperatively, Respectively
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