Fully Endoscopic 360° Decompression Surgery for Thoracic Spinal Stenosis: Technical Note and Report of 8 Cases

Abstract

Background: Surgical 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.

Objectives: To evaluate the outcome and safety of combining fully endoscopic transforaminal and posterior approaches for ventral and dorsal decompression of thoracic spinal stenosis.

Study design: Retrospective case review.

Setting: Single-center acute-care hospital.

Methods: Eight 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.

Results: Successful 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.

Limitations: Small case series evaluated retrospectively with 15-month average follow-up.

Conclusions: Combining 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.

Keywords: bilateral laminotomy/unilateral approach; fully endoscopic; myelopathy; transforaminal; Thoracic spinal stenosis.