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Background and objectives <p>To evaluate the reliability and clinical applicability of a novel classification system for thoracic posterior longitudinal ligament ossification (OPLL) and its utility in guiding surgical approach selection for anterior controllable ante-displacement fusion (TACAF).</p> Methods <p>Based on anatomical and clinical characteristics, thoracic OPLL was classified according to: Grades 1–4 (severity), Zones A–B (location), and Arc morphology (kyphotic curvature). Twenty surgeons independently assessed 50 cases to evaluate system reliability. Fleiss kappa coefficients determined inter- and intra-observer agreement. Clinical validation utilized demographic and perioperative data from 50 patients, including: Neurological function (11-point JOA scale), operative time, blood loss, and major complications.</p> Results <p>For grade 3/4 or zone A OPLL, anterior approaches were predominantly preferred. Grade 2 or zone B lesions permitted selective ossification resection. Laminectomy was contraindicated for grade 4 OPLL. Lesions nearer the arc vertex consistently required anterior approaches. All cases managed per recommended protocols demonstrated uniformly excellent JOA score improvement rates across grades/zones, without statistically significant differences.</p> Conclusion <p>This novel classification system provides reliable and reproducible standardization for thoracic OPLL, effectively guiding surgical decision-making. Clinical outcomes and complication analyses in 50 patients support its validity for selecting thoracic OPLL decompression methods.</p>

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A TACAF-based classification system for thoracic posterior longitudinal ligament ossification

  • 期刊论文

  • 发表日期：

    2025年8月18日

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  • Shunmin Wang,
  • Yangzi Yang,
  • Tiefeng Li,
  • Ximing Xu,
  • Yuan Wang,
  • Jiuyi Sun,
  • Jiangang Shi

摘要

Background and objectives

To evaluate the reliability and clinical applicability of a novel classification system for thoracic posterior longitudinal ligament ossification (OPLL) and its utility in guiding surgical approach selection for anterior controllable ante-displacement fusion (TACAF).

Methods

Based on anatomical and clinical characteristics, thoracic OPLL was classified according to: Grades 1–4 (severity), Zones A–B (location), and Arc morphology (kyphotic curvature). Twenty surgeons independently assessed 50 cases to evaluate system reliability. Fleiss kappa coefficients determined inter- and intra-observer agreement. Clinical validation utilized demographic and perioperative data from 50 patients, including: Neurological function (11-point JOA scale), operative time, blood loss, and major complications.

Results

For grade 3/4 or zone A OPLL, anterior approaches were predominantly preferred. Grade 2 or zone B lesions permitted selective ossification resection. Laminectomy was contraindicated for grade 4 OPLL. Lesions nearer the arc vertex consistently required anterior approaches. All cases managed per recommended protocols demonstrated uniformly excellent JOA score improvement rates across grades/zones, without statistically significant differences.

Conclusion

This novel classification system provides reliable and reproducible standardization for thoracic OPLL, effectively guiding surgical decision-making. Clinical outcomes and complication analyses in 50 patients support its validity for selecting thoracic OPLL decompression methods.