Comparative Clinical and Radiographic Cohort Study: Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression by Using the 1-Block Resection Technique and Thoracic Open Laminotomy With Bilateral Decompression for Thoracic Ossified Ligamentum Flavum

Abstract

BACKGROUND: Symptomatic thoracic myelopathy secondary to thoracic ossified ligamentum flavum (OLF) often requires decompression spinal surgery. OBJECTIVE: To compare clinical and radiological outcomes in uniportal endoscopic vs open thoracic decompression for thoracic OLF. METHODS: Retrospective evaluation of patients who underwent uniportal thoracic endoscopic unilateral laminotomy with bilateral decompression (TE-ULBD) by using the oneblock resection technique compared with thoracic open laminotomy (TOL) with bilateral decompression. Radiological outcomes in MRI scan and clinical charts were evaluated. RESULTS: Thirty-five levels of TE-ULBD were compared with 24 levels of TOL. The overall complication rate of TOL was 15% while TE-ULBD was 6.5%. Both TOL and TE-ULBD cohort had significantly improved their visual analog scale (VAS), Oswestry Disability Index, and Japanese Orthopaedic Association (JOA) myelopathy score after operation. Comparative analysis of TE-ULBD performed statistically and significantly better than TOL in improvement of final VAS and JOA scores. The mean difference ± standard deviation of VAS and JOA improvement in final follow-up when compared with preoperative state of TE-ULBD and TOL was 0.717 ± 0.131 and 1.03 ± 0.2, respectively, P < .05. The mean Hirabayashi recovery rates were 94.5% (TE-ULBD) and 56.8% (TOL). There was no statistical difference in change in preoperative and final Oswestry Disability Index and MRI volume at upper endplate, middisk, and lower endplate canal cross-sectional area. CONCLUSION: Uniportal TE-ULBD achieved significantly improved pain and neurological recovery with sufficient spinal canal decompression, as compared with thoracic open laminectomy for patients with myelopathy secondary to OLF in our cohort.

Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes

“…Full endoscopic surgery has also been used as an en bloc removal technique to treat thoracic OLF and has shown favorable surgical outcomes. 13 In this study, no neurological complications occurred after using the outside-in decompression method.…”

“…4,9,10 Full endoscopic thoracic approaches have been used to treat thoracic stenosis and have shown good surgical outcomes. [11][12][13][14][15] Biportal endoscopic surgery has also been described as a surgical technique to treat cervical and thoracic spondylotic myelopathy. [16][17][18] Additional pressure on a compressed spinal cord can induce irreversible neural injury.…”

Consecutive Case Series of Uniportal Full‐endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: Relationship between Decompression Range and Functional Outcomes

“…Uniportal full endoscopy (UFE) is a minimally invasive technique used to treat lumbar disc herniation, cervical spondylopathy, and thoracic ossified ligamentum flavum 4–6 . Furthermore, uniportal full‐endoscopic ULBD (UFE‐ULBD) reportedly has excellent clinical and radiological outcomes in LSS patients 7–9 .…”

Commentary: Comparative Clinical and Radiographic Cohort Study: Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression by Using the 1-Block Resection Technique and Thoracic Open Laminotomy With Bilateral Decompression for Thoracic Ossified Ligamentum Flavum

“…The results of outcomes were compared in both groups; it has been concluded that TE-ULBD is superior to TOL regarding better pain improvement, as evaluated by the Japanese Orthopedic Association scoring system and the lower incidence of complications. 1 The article is well-written, and the topic is interesting; however, it is important to highlight some issues pertaining to this subject.…”

“…Another important advantage is that it compares 2 surgical procedures, endoscopic treatment and open surgical decompression. 1 However, the study does not provide much information regarding preoperative neurological data, neurophysiological monitoring, amount of blood loss, hospitalization time, and protocol of medical treatment. Furthermore, the lack of preoperative sagittal computed tomography scan and sagittal MRI might have resulted in nonrecognition of important types of OLF such as the beak type.…”