A 40-year-old woman presented with thoracic myelopathy due to OPLL, extending from T2–T9. We performed a posterior laminectomy and instrumented fusion. However, postoperative paraplegia occurred within 36 h post-surgery. Emergent anterior decompression and interbody fusion was performed via the trans-thoracic approach. Neurological deterioration was reversed following this anterior procedure. Posterior decompression and instrumented fusion for thoracic OPLL is less technically demanding and presents a lower risk of neurological complications. However, some controversies remain regarding the prevalence and management of postoperative neurological deterioration associated with this technique. Our patient showed recovery with subsequent anterior decompression when paraplegia occurred after posterior decompression and fusion to treat thoracic OPLL. Additional anterior decompression should be considered when posterior decompression and fusion lead to neurological deterioration. Keywords : Fusion, Laminectomy, OPLL, Postoperative paraplegia, Thoracic