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KMID : 0388720220290040143
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Journal of Korean Society of Spine Surgery
2022 Volume.29 No. 4 p.143 ~ p.151
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Awake Unilateral Biportal Endoscopic Thoracic Decompression - Technical Note -
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Kang Tae-Hoon
Kim Won-Joong
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Abstract
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Study design: Technical note.
Objective: This study aimed to report the results of thoracic myelopathy patients treated with awake unilateral biportal endoscopic decompression and show the possibility of intraoperative neuromonitoring using verbal commands.
Summary of Literature Review: Surgical decompression is necessary for most thoracic myelopathies. To avoid cord
injury, intraoperative neuromonitoring is recommended. If thoracic decompression is possible under local anesthesia, awake surgery with intraoperative neuromonitoring using verbal commands is possible.
Materials and Methods: We retrospectively reviewed three thoracic myelopathy patients treated with awake decompression between March and May 2022. Partial hemilaminectomies with unilateral biportal endoscopy under local anesthesia were performed. The patients were asked to move their legs in response to verbal commands intraoperatively.
Results: The patients’ average age was 78.7 years (range, 75-83 years). The average number of levels of surgery was 1.3 (range, 1-2).
The average surgical time was 55 minutes. There were no neurological or other complications. Numeric rating scale (NRS) scores during the procedure were lower than 3. The NRS score of back pain improved from 4.6 preoperatively to 2 postoperatively, while that of leg pain improved from 6 to 1.3 at the discharge day. The modified Japanese Orthopaedic Association scores changed from 5.3 preoperatively to 8.6 at postoperative 1 month.
Conclusions: Awake thoracic decompression with unilateral biportal endoscopy can be an alternative for decompression in thoracic myelopathy, avoiding neurological complications.
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KEYWORD
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Awake spine surgery, Stagnara test, Thoracic myelopathy, Unilateral biportal endoscopic thoracic decompression, Intraoperative neuromonitoring
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