Thoracic controllable antedisplacement and fusion in the treatment of multilevel thoracic ossification of the posterior longitudinal ligament: a case series with technical notes

Surgically managing multilevel thoracic ossification of the posterior longitudinal ligament (mT-OPLL) remains technically challenging. Recently, a novel technique called thoracic controllable antedisplacement and fusion (TCAF) has been proposed as an encouraging procedure for this disorder. This study aimed to offer evidence regarding the safety and efficacy of TCAF surgery through a case series of mT-OPLL patients treated with this new technique. Between August 2021 and May 2025, 3 consecutive cases of mT-OPLL treated by the TCAF surgery were retrospectively reviewed, and their surgery-related data and complications were collected. Additionally, the modified Japanese Orthopedic Association (mJOA) score, American Spinal Injury Association (ASIA) grade, and imaging parameters, including the type, involved levels, maximal thickness (mT) and maximal occupation ratio (mOR) of T-OPLL, spinal canal area (SCA) and diameter (SCD) at the narrowest level, and antedisplacement distance (AD) of the thoracic column, were evaluated before surgery and/or at the final follow-up. TCAF surgeries were successfully conducted in all patients (1 male and 2 females), and the average surgical level, operation time, blood loss, and hospitalization length were 8.33 ± 1.53, 530.00 ± 105.36 min, 600.00 ± 100.00 ml, and 20.00 ± 6.25 days, respectively. The mean mT and T-OPLL were 7.73 ± 1.05 mm and 7.67 ± 2.08, respectively. The average AD was 5.90 ± 0.20 mm. At the last visit, each patient achieved solid bony fusion with improved mOR, SCA and SCD. The average mJOA scores at the final visit were relatively greater than that before the operation (8.00 ± 1.00 vs. 3.67 ± 1.15), with a mean recovery rate of 59.72 ± 8.67%. In addition, the ASIA grades at the last visit improved in 2 patients but remained unchanged in 1 patient. No neurological deterioration or other serious complications occurred postoperatively, except for 1 case of cerebrospinal fluid leakage. The TCAF procedure, which allows canal decompression with no need for removal of T-OPLL, could be a promising surgical alternative for safely and effectively managing mT-OPLL.