Endoscopic “cave-in” technique for massive thoracic ossification of the posterior longitudinal ligament combined with thoracic disc herniation with 36 months of follow-up: a case report and review of the literature

• Published in: European spine journal Vol. 34; no. 4; pp. 1433 - 1438
• Main Authors: Wan, Junpei, Deng, Shihao, Huang, Jianfeng, Zou, Guoyao, Shen, Chong
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2025; Springer Nature B.V
• Subjects: Aged; Case Report; Case reports; Caves; Central nervous system diseases; Computed tomography; Decompression; Decompression, Surgical - methods; Endoscopy; Endoscopy - methods; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - diagnostic imaging; Intervertebral Disc Displacement - surgery; Intervertebral discs; Ligaments; Limbs; Literature reviews; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurosurgery; Ossification; Ossification of Posterior Longitudinal Ligament - complications; Ossification of Posterior Longitudinal Ligament - diagnostic imaging; Ossification of Posterior Longitudinal Ligament - surgery; Patients; Spinal cord; Spinal stenosis; Surgical Orthopedics; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Thorax; Treatment Outcome; Case report and literature review; Thoracic ossification of the posterior longitudinal ligament; Thoracic disc herniation; Endoscopic technique; “Cave-in” technique
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-025-08687-2

Background Both thoracic ossification of the posterior longitudinal ligament (T-OPLL) and thoracic disc herniation (TDH) may cause thoracic spinal stenosis (TSS) resulting in thoracic myelopathy. Surgical decompression is the only effective treatment for symptomatic TSS. 360° Circumferential decompression, also called the “cave-in” technique, can safely and effectively treat T-OPLL; however, this procedure has not yet been performed endoscopically. Herein, we report the first case of massive T-OPLL combined with TDH that was treated endoscopically using the “cave-in” technique, with 36 months of follow-up. Further, we review the literature on this subject. Case Report A 76-year-old woman presented with a 2-year history of progressive numbness and weakness of both lower limbs, and pain and weakness in both lower limbs after sustaining a fall more than 1 month ago, with symptom aggravation since 1 week. Computed tomography (CT) revealed TDH combined with massive T-OPLL at the T6/7 levels. Magnetic resonance imaging (MRI) showed severe compression of the thoracic spinal cord. Two-stage endoscopic circumferential decompression was performed. During a follow-up period of 36 months, the patient recovered with no complications, and CT and MRI confirmed complete decompression of the spinal cord. Conclusion The endoscopic “cave-in” technique can effectively treat T-OPLL with satisfactory clinical results, and is associated with less trauma and fewer complications than conventional posterior circumferential decompression. The endoscopic “cave-in” technique can be a good surgical option for patients with T-OPLL.