A rare case of giant calcified thoracic disc herniation, OPLL and OLF: how I do it

BACKGROUND: Thoracic myelopathy can have different aetiologies. Based on the location and on the nature of spinal cord compression, different surgical approaches may be indicated. METHOD: We present a rare case of thoracic myelopathy caused by the coexistence of a giant disc herniation, OPLL and OLF, and we describe the surgical approach, with a focus on technical nuances and strategies to avoid complications. CONCLUSION: Careful presurgical planning and microsurgery are fundamental in achieving a satisfactory spinal cord decompression. IONM, endoscopy-assisted microsurgery and intraoperative navigation can enhance the safety of surgery and the extent of safe surgical decompression. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-021-04887-z.