• Changkun Zheng, Zhong Liao, and Hui-Zhen Chen.
• Department of Spine, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian, China; Department of Spine, Fujian Provinical Clinical MedIcal Research Center for First Aid and Rehabiliation in Orthopaedic Trauma (2021), Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian, China. Electronic address: zck20212021@163.com.
• World Neurosurg. 2021 Dec 1; 156: e249-e253.

BackgroundThoracic ossification of the ligamentum flavum (OLF) is a pathologic condition that affects ligamentation of the OLF and causes slowly progressive myeloradiculopathy. There is a trend toward performing minimally invasive surgery. In this study, we assess the long-term efficacy of percutaneous endoscopic surgical management of thoracic OLF.MethodsTwenty patients with thoracic myelopathy due to thoracic OLF underwent percutaneous endoscopic surgical management. We investigated clinical outcomes and neurologic improvements. Magnetic resonance imaging was performed on all patients preoperatively and postoperatively, and intramedullary signal changes were evaluated.ResultsThe operation time averaged at 170.4 minutes (range 110-320 minutes). The mean intraoperative blood loss was 29.6 mL (range 5-100 mL). Cerebrospinal fluid leakage occurred in 1 patient and healed well. The follow-up period ranged from 60 to 72 months. The mean score on the Japanese Orthopedic Association scale improved from (6.0 ± 1.41) preoperatively to (7.83 ± 1.40) at 1 month postoperatively to (9.67 ± 1.30) at the final follow-up (P < 0.05). At the final follow-up stage, 11 patients had excellent outcomes, 6 good, 2 fair, and 1 unchanged, according to the Hirabayashi recovery rate. No patient had postoperative deterioration in neurologic status.ConclusionsPercutaneous endoscopic surgical management of thoracic OLF has proven to be both safe and effective for the resection of the OLF in the thoracic spine.Copyright © 2021 Elsevier Inc. All rights reserved.

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