Unilateral Biportal Endoscopic Decompression for Thoracic Spinal Stenosis

Abstract

In conventional thoracic laminectomy, postoperative complications such as dural tears, cerebrospinal fluid leakage, postoperative infection, and iatrogenic spinal cord injury are relatively common. To address these issues, unilateral biportal endoscopy (UBE) techniques for thoracic laminectomy have been developed and published, demonstrating various advantages over conventional thoracic laminectomy with satisfactory clinical results. In comparison to conventional thoracic laminectomy, the UBE decompression technique with the unilateral approach and bilateral decompression (ULBD) appears to be safe and effective for treating thoracic ossified ligamentum flavum (OLF) or thoracic spinal stenosis. Thoracic ULBD by UBE preserves the paraspinal muscle and ligament that would otherwise be resected during the conventional posterior approach, and it has the added benefit of reducing back pain and muscle atrophy. This manuscript covers the technical aspects of UBE implementation using thoracic ULBD in patients with thoracic OLF or thoracic spinal stenosis, the indications and benefits of this procedure, and tips for preventing complications. With a review of previously published articles on thoracic laminectomy by UBE, we also summarize whether the procedure is safe and can prevent cord injuries.