• Jian Shen and Albert E Telfeian.
• Shen-Spine, New York, NY and Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI.
• Pain Physician. 2020 Nov 1; 23 (6): E659-E663.

BackgroundSurgical options for treating thoracic spinal cord compression that results from circumferential stenosis typically involve instrumented fusion procedures. The authors present here an outpatient, awake, endoscopic surgical option for treating thoracic stenosis that avoids fusion.ObjectivesTo evaluate the outcome and safety of combining fully endoscopic transforaminal and posterior approaches for ventral and dorsal decompression of thoracic spinal stenosis.Study DesignRetrospective case review.SettingSingle-center acute-care hospital.MethodsEight patients with single-level, significant stenosis of the thoracic spinal canal were treated with fully endoscopic transforaminal and posterior approaches to achieve 360° ventral and dorsal decompression. Patients were followed up to 30 months postoperatively. Axial back pain was measured by the Visual Analog Scale (VAS) score, and paired Student t-test was used for statistical analysis.ResultsSuccessful decompression was achieved in all 8 patients. All surgeries were performed as outpatient procedures under local anesthesia with intravenous (IV) sedation. There were no intraoperative dura tears, spinal cord or nerve root injury, postoperative infections, or cases of iatrogenic-induced segmental instability. All patients had significant improvement with VAS scores significantly lower postoperatively.LimitationsSmall case series evaluated retrospectively with 15-month average follow-up.ConclusionsCombining fully endoscopic transforaminal and posterior approaches for both ventral and dorsal decompression under local anesthesia with IV sedation is an effective and safe minimally invasive surgical treatment for thoracic spinal stenosis.

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