Uniportal thoracic endoscopic decompression using one block resection technique for thoracic ossified ligamentum flavum technical report

Introduction: There is paucity of literature on application of endoscopic spine surgery in thoracic spine for ossified ligamentum flavum. We aim to evaluate the clinical and radiological outcomes Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression Using One Block Resection Technique (TE-ULBD) for Thoracic Ossified Ligamentum Flavum in our cohort of patients. Methods: Retrospective evaluation performed for all patients who underwent TE-ULBD for thoracic ossified ligamentum flavum. Pre and postoperative parameters of axial cut spinal canal area in upper, middle and lower disc, VAS, ODI and JOA at preoperative, postoperative 1 week, 6 months and final follow up were compared. Results: 35 levels of TE-ULBD performed in 28 patients. The complication rate of TE-ULBD was 2.8%. In our TEULBD cohort there was significant clinical improvement in VAS, ODI and JOA score in postoperative 1 week, 6 months and final score. The mean difference as compared to preoperative VAS in postoperative final follow up 4.80, p < 0.05. The mean difference as compared final follow up (40.8), p < 0.05. The mean as compared to preoperative JOA in final follow up 2.57, p < 0.05. MacNab score showed 11 good and 17 excellent scores in 28 patients. There was significant statistical increase in decompression cross section spinal canal area (SCA) dimension in postoperative compared to preoperative MRI scan with mean increase of 1) upper disc 30.81 mm(2), 2) middle disc 34.68 mm(2) 3) lower disc 26.18 mm(2), p < 0.05. Conclusion: Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression Using One Block Resection Technique was able to achieve adequate spinal canal decompression with significantly improved pain, functional status and neurological recovery in our cohort of patients.