• Pang Hung Wu, ChinBrian Zhao JieBZJNational University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore; National University Health System, Kent Ridge Campus, Orthopaedic Surgery, Singapore., Hyeun Sung Kim, Seth Ian Sim, and Il-Tae Jang.
• Achieve Spine And Orthopaedic Centre, Mount Elizabeth Hospital, Singapore; National University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore.
• World Neurosurg. 2023 Oct 1; 178: 340350.e2340-350.e2.

BackgroundThoracic ossification of ligamentum flavum (TOLF) is a rare disease that often results in worsening neurologic sequelae if left untreated. Although the gold standard treatment for TOLF is open posterior laminectomy, it is often accompanied by high rates of complications and perioperative morbidity. There have been studies looking into feasibility of endoscopic posterior decompression for TOLF, citing potential for lower perioperative morbidity and achieving similar functional outcomes to its open laminectomy counterparts. We provide an up-to-date systematic review of clinical outcomes after endoscopic posterior decompression for TOLF from the latest assemblage of evidence.MethodsA systematic review of the technique was conducted from May 2000 to May 2023. Articles were selected based on PRISMA guidelines. Eligibility of studies was independently by 2 reviewers, with disagreements resolved by a third author.ResultsNineteen primary references comprising 337 patients with TOLF who underwent endoscopic posterior decompression were included in the systematic review. Mean follow-up time across all studies ranged from 8.9 to 65.3 months. Mean age ranged from 51.2 to 63 years, with mean intraoperative blood loss ranging from 15 to 62 mL. There is significant improvement in visual analog scale (VAS) score, VAS back, VAS leg, modified Japanese Orthopaedic Association score, and Oswestry Disability Index compared with preoperative recorded values across all studies, with low rates of complications reported.ConclusionsEndoscopic posterior spinal decompression is a safe and effective technique for treatment of TOLF, with a low rate of complications and improvement in pain and function.Copyright © 2023. Published by Elsevier Inc.

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