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KMID : 1040920230080010074
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Journal of Minimally Invasive Spine Surgery and Technique
2023 Volume.8 No. 1 p.74 ~ p.81
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Clinical Results and Review of Techniques of Thoracic Endoscopic Unilateral Laminotomy with Bilateral Decompression (TE-ULBD) Using the Outside-In Technique for Thoracic Ossified Ligamentum Flavum
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Kim Hyeun-Sung
Pang Hung Wu
Jang Il-Tae
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Abstract
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Objective : Uniportal full endoscopic thoracic endoscopic surgery can be performed through transforaminal and interlaminar approaches. The interlaminar approach is commonly described as thoracic endoscopic unilateral laminotomy for bilateral decompression (TE-ULBD), which is typically indicated for pathologies such as ossified ligamentum flavum and other posteriorly based compressive pathologies. TE-ULBD decompresses the central and lateral recesses of the thoracic spinal canal. Both the outside-in (over the top of ligamentum flavum) and inside-out (under the ligamentum flavum) approaches can decompress the thoracic spinal canal through the uniportal interlaminar endoscopic route.
Methods : A retrospective clinical cohort evaluation of patients who underwent TE-ULBD was performed from January 2018 to December 2021
Results : A cohort of 50 cases of TE-ULBD with a mean age of 65 years old were evaluated. The complication rate was 5.4% and the reoperation rate was 2%. Statistically significant mean VAS improvements were found at 1 week, 6 months, and the final follow-up, with changes of 3.95±1.49, 4.95±1.7, and 5.2±1.8 points, respectively. Likewise, the mean Oswestry Disability Index improvements at 1 week, 3 months, and the final follow-up were 33.8±9.05, 40.12±10.38, and 41.92±11.26, respectively (p<0.001). Significant improvements were found in the cross-sectional area of the spinal canal in the upper endplate, mid-disc, and lower endplate (57.62±50.6, 89.86±55.93, and 64.93±60.91 mm2, respectively; p<0.001).
Conclusion : TE-ULBD using the outside-in technique could achieve good clinical outcomes and a low rate of complications in our cohort of patients.
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KEYWORD
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Spinal stenosis, Endoscopic spine surgery, Minimally Invasive Spine Surgery, thoracic spine, Ligamentum flavum, Omit foraminal ligament
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