AUTHOR=Jing Xiaowei , Gong Zhiyuan , Qiu Xiaowen , Zhong Zhuolin , Ping ZiChuan , Hu Qingfeng 

TITLE=“Cave-in” decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1030999

DOI=10.3389/fsurg.2022.1030999

ISSN=2296-875X

ABSTRACT=Background: Thoracic ossification of the posterior longitudinal ligament (TOPLL) requires surgery for spinal cord decompression. Traditional open surgery is highly invasive and has many complications. Unilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery, especially in the lumbar, but rare in the thoracic spine. In this study, we first used a new percutaneous UBE “cave-in” decompression technique for the treatment of beak-type TOPLL.
Methods: A 31-year-old female with distinct zonesthesia and numbness below the T3 dermatome caused by baked-type TOPLL(T2-3) underwent a 2-step UBE decompression procedure. First step, the ipsilateral lamina, left facet joint, partial transverse processes, and pedicles of T2 and T3 were removed. Second step, a cave was created by removing posterior third of the vertebral body (T2-3). The eggshell-like TOPLL was excised by forceps and the dura sac was decompressed. All procedures are performed under endoscopic guidance. The drainage tube was inserted and the incisions were closed after conforming the decompress scope by C-arm. The patient’s pre- and postoperative radiological and clinical results were evaluated.
Results: Postoperative CT and MR films conformed the spinal cord was complete decompressed. The patient's lower extremity muscle strength was greatly improved and no complication occurred. The MJOA score was improved from 5 to 7, and the recovery rate was 33.3%.
Conclusion: UBE spinal decompression for TOPLL showed a fevorable clinical and radiological result, and offers the advantage of minimal soft tissue dissection, shorter hospital stay, and faster return to daily life activities.