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Introduction <p>Endoscopic decompression is a favorable option for the treatment of spinal diseases. However, there have been few reports of unilateral biportal endoscopy-assisted unilateral laminotomy for bilateral decompression (UBE-ULBD) for the treatment of severe thoracic spinal stenosis (TSS) and ossification of ligamentum flavum (OLF) with a high ossification occupancy ratio. The purpose was to evaluate the safety and efficacy of UBE-ULBD for the treatment of severe TSS-OLF with an occupancy ratio &gt; 60%.</p> Methods <p>The retrospective cohort study enrolled 40 patients with TSS-OLF from January 2021 to August 2023. All the patients presented with typical neurological symptoms with radiological one- or two-level thoracic OLF, receiving UBE-ULBD surgery with at least 2&#xa0;years of follow-up. Preoperative and postoperative clinical and radiological data were reviewed and analyzed. In addition, operative time, postoperative drainage, postoperative length of stay, and complications were also recorded.</p> Results <p>There were 33 cases of TSS-OLF with a single level and 7 two-level cases included in the study. The UBE-ULBD surgery was successfully performed for all the patients with an average operative time of 111.6&#xa0;min/level. The mean follow-up time was 33.5 ± 6.4&#xa0;months. The modified Japanese Orthopaedic Association (mJOA) score (9.1 ± 0.8 vs. 5.3 ± 1.0) and Oswestry Disability Index (ODI) (31.8 ± 5.2 vs. 46.4 ± 3.3) were significantly improved at last follow-up compared to the preoperative score. The mean recovery rate (RR) was 65.0%, with an effective rate of 100%. The mean preoperative ossification occupancy ratio was 76.7% and the ossification was removed for all cases with adequate decompression and radiological outcomes. The mean dural sac cross-sectional area (DSCA) expansion rate in magnetic resonance imaging (MRI) was 228.4 ± 115.8%.</p> Conclusions <p>UBE-ULBD is a technically demanding and feasible, efficient, and minimally invasive option for the treatment of severe one- or two-level OLF-TSS with a high ossification occupancy ratio &gt; 60% with excellent clinical and radiological outcomes.</p>

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The Safety and Efficacy of Unilateral Biportal Endoscopic Decompression for the Treatment of Thoracic Ossification of Ligamentum Flavum with Occupancy Ratio > 60%: A Retrospective Cohort Study

  • 期刊论文

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  • 发表日期：

    2025年12月20日

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  • Lei Qi,
  • Biteng Xu,
  • Xiangji Guo,
  • Gaoya Yu,
  • Yuxuan Yang,
  • Haozhi Yu,
  • Liang Wang

摘要

Introduction

Endoscopic decompression is a favorable option for the treatment of spinal diseases. However, there have been few reports of unilateral biportal endoscopy-assisted unilateral laminotomy for bilateral decompression (UBE-ULBD) for the treatment of severe thoracic spinal stenosis (TSS) and ossification of ligamentum flavum (OLF) with a high ossification occupancy ratio. The purpose was to evaluate the safety and efficacy of UBE-ULBD for the treatment of severe TSS-OLF with an occupancy ratio > 60%.

Methods

The retrospective cohort study enrolled 40 patients with TSS-OLF from January 2021 to August 2023. All the patients presented with typical neurological symptoms with radiological one- or two-level thoracic OLF, receiving UBE-ULBD surgery with at least 2 years of follow-up. Preoperative and postoperative clinical and radiological data were reviewed and analyzed. In addition, operative time, postoperative drainage, postoperative length of stay, and complications were also recorded.

Results

There were 33 cases of TSS-OLF with a single level and 7 two-level cases included in the study. The UBE-ULBD surgery was successfully performed for all the patients with an average operative time of 111.6 min/level. The mean follow-up time was 33.5 ± 6.4 months. The modified Japanese Orthopaedic Association (mJOA) score (9.1 ± 0.8 vs. 5.3 ± 1.0) and Oswestry Disability Index (ODI) (31.8 ± 5.2 vs. 46.4 ± 3.3) were significantly improved at last follow-up compared to the preoperative score. The mean recovery rate (RR) was 65.0%, with an effective rate of 100%. The mean preoperative ossification occupancy ratio was 76.7% and the ossification was removed for all cases with adequate decompression and radiological outcomes. The mean dural sac cross-sectional area (DSCA) expansion rate in magnetic resonance imaging (MRI) was 228.4 ± 115.8%.

Conclusions

UBE-ULBD is a technically demanding and feasible, efficient, and minimally invasive option for the treatment of severe one- or two-level OLF-TSS with a high ossification occupancy ratio > 60% with excellent clinical and radiological outcomes.