Article: How i do it: biportal endoscopic thoracic decompression for ossification of the ligamentum flavum

Background: Currently, decompressive laminectomy with or without concomitant fusion is a standard treatment for ossification of the ligamentum flavum (OLF). However, conventional thoracic decompressive laminectomy is not free of the inevitable destruction of the posterior ligamentous complex, and facet injury may lead to various sequelae.

Method: We used the biportal endoscopic technique for posterior thoracic decompression (BE-PTD) and describe the steps with discussion regarding the indications, advantages, possible complications, and ways to overcome complications.

Conclusion: BE-PTD can obtain endoscopic visualizations of all the boundaries of the OLF lesion and achieve direct neural decompression of thoracic OLF.

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References

1.

Ahn D, Lee S, Moon S, Boo K, Chang B, Lee J . Ossification of the ligamentum flavum. Asian Spine J. 2014; 8(1):89-96. PMC: 3939377. DOI: 10.4184/asj.2014.8.1.89. View

2.

Aizawa T, Sato T, Sasaki H, Kusakabe T, Morozumi N, Kokubun S . Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. J Neurosurg Spine. 2006; 5(6):514-9. DOI: 10.3171/spi.2006.5.6.514. View

3.

An B, Li X, Zhou C, Wang B, Gao H, Ma H . Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum. Eur Spine J. 2019; 28(3):492-501. DOI: 10.1007/s00586-018-05866-2. View

4.

Baba S, Oshima Y, Iwahori T, Takano Y, Inanami H, Koga H . Microendoscopic posterior decompression for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum: a technical report. Eur Spine J. 2015; 25(6):1912-9. DOI: 10.1007/s00586-015-4158-9. View

5.

Choi G, Kang H, Modi H, Prada N, Nicolau R, Joh J . Risk of developing seizure after percutaneous endoscopic lumbar discectomy. J Spinal Disord Tech. 2010; 24(2):83-92. DOI: 10.1097/BSD.0b013e3181ddf124. View

6.

Kang M, Park H, Hwang J, Kim J, Choi D, Chung H . Safety Evaluation of Biportal Endoscopic Lumbar Discectomy: Assessment of Cervical Epidural Pressure During Surgery. Spine (Phila Pa 1976). 2020; 45(20):E1349-E1356. DOI: 10.1097/BRS.0000000000003585. View

7.

Kubota T, Kawano H, Yamashima T, Ikeda K, Hayashi M, Yamamoto S . Ultrastructural study of calcification process in the ligamentum flavum of the cervical spine. Spine (Phila Pa 1976). 1987; 12(4):317-23. DOI: 10.1097/00007632-198705000-00002. View

8.

Kuh S, Kim Y, Cho Y, Jin B, Kim K, Yoon Y . Contributing factors affecting the prognosis surgical outcome for thoracic OLF. Eur Spine J. 2005; 15(4):485-91. PMC: 3489313. DOI: 10.1007/s00586-005-0903-9. View

9.

Okada K, Oka S, Tohge K, Ono K, Yonenobu K, Hosoya T . Thoracic myelopathy caused by ossification of the ligamentum flavum. Clinicopathologic study and surgical treatment. Spine (Phila Pa 1976). 1991; 16(3):280-7. DOI: 10.1097/00007632-199103000-00005. View

10.

Osman N, Cheung Z, Hussain A, Phan K, Arvind V, Vig K . Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976). 2018; 43(14):E842-E848. PMC: 6252088. DOI: 10.1097/BRS.0000000000002563. View

How I Do It: Biportal Endoscopic Thoracic Decompression for Ossification of the Ligamentum Flavum