ABSTRACT
The most common causes of ventral thoracic spinal cord compression are calcified herniated discs and ossification of the posterior longitudinal ligament (OPLL), which can cause significant scarring and damage to the underlying dura. Realistic expectations need to be fully discussed with the patient preoperatively, which requires highlighting the risk of requiring subsequent interventions, given the high rate of dural violations with calcified herniated disks and OPLL. A clear understanding of the delicate balance between negative pressure chest tube management and the exacerbation of ventral dural defect is also paramount and requires constant communication between the spine and thoracic approach surgeons. A lumbar drain should be placed either preoperatively or intraoperatively following ventral thoracic dural defect repair. When rotating the spinal cord using cut dentate ligaments to identify the dural defect intradurally, neuromonitoring is paramount. Abrupt changes in monitoring require a less aggressive rotation maneuver.
