Advanced Technique of 360° Decompression for Thoracic Spondylotic Myelopathy Using the Biportal Endoscopic Posterior Approach

Objective: Biportal endoscopic surgery was developed to treat degenerative pathologies that cause myelopathy. Thoracic disc herniation accelerates myelopathy at the level of thoracic stenosis caused by ossification of the ligamentum flavum (OLF). This study describes a feasible surgical technique for the biportal endoscopic posterior approach for removing the thoracic OLF and herniated disc that cause thoracic myelopathy.Methods: Bilateral laminar thinning was performed while preserving the midline and contralateral bony structures. The thoracic OLF was thinned and cut at the bony drilled edge using a diamond drill. The OLF was elevated and removed using an en bloc technique after epidural dissection. The herniated disc was removed through the space created after medial facetectomy. All the procedures were performed without neural injury.Results: Postoperatively, the neurological symptoms of thoracic myelopathy improved, as did the upper back and chest wall pain.Conclusion: We successfully treated double-crushing lesions of the thoracic herniated disc and OLF using biportal endoscopy. In biportal endoscopic surgery, drills and instruments can be smoothly used in the narrow spinal canal of the upper thoracic vertebrae. The biportal endoscopic posterior thoracic approach may be an attractive surgical option for treating thoracic myelopathy caused by combined degenerative pathologies.