Background: Resection of the ossification of the thoracic ligamentum flavum (OTLF) with a
high-speed burr may cause a high rate of perioperative complications, such as dural laceration
and/or iatrogenic spinal cord injury.
Objectives: The aim of this study was to investigate the safety and feasibility of the endoscopicmatched
ultrasonic osteotome in full-endoscopic spinal surgery for direct removal of OTLF.
Study Design: Retrospective study.
Setting: All data were from Honghui Hospital in Xi’an.
Methods: This study conducted between December 2017 and December 2018, included 27
consecutive patients who met the study criteria, had single-level OTLF, and underwent fullendoscopic
decompression under local anesthesia. The postoperative follow-up was scheduled
at 1, 3, 6, and 12 months postoperatively. Outcomes evaluations included the Visual Analog
Scale (VAS) score for lower extremity pain and the modified Japanese Orthopaedic Association
(mJOA) score and improvement rate for the assessment of thoracic myelopathy. Removal of
OTLF was measured by comparing the pre- and postoperative computed tomography (CT) and
magnetic resonance imaging (MRI) scans.
Results: The operation was completed in all patients without conversion to open surgery.
The operation time ranged from 65 to 125 minutes (average, 83.7 ± 12.3 minutes). All
patients were followed up for 12 to 18 months, with an average follow-up of 14.3 ± 1.3
months. Satisfactory neurologic decompression was confirmed by postoperative CT and MRI,
and no revision surgery was required. The VAS and mJOA scores showed statistically higher
improvement at the 1-month follow-up and the last follow-up compared with the preoperative
assessment (P < 0.05). According to the improvement rate at the final follow-up, 20 cases were
classified as good, 6 cases were fair, and 1 case remained unchanged.
Limitations: A single-center, noncontrol study.
Conclusions: The endoscopic-matched ultrasonic osteotome can be considered quite safe
and feasible for direct removal of OTLF during full-endoscopic spinal surgery in strictly selected
patients, as this allows for effective direct decompression of OTLF while minimizing trauma and
instability. In addition, because of the design characteristics of the ultrasonic osteotome, surgical
complications, especially dural tears and spinal cord injury, can also be effectively controlled.
Key words: Percutaneous endoscopic spinal surgery, ultrasonic osteotome, ossification of
thoracic ligamentum flavum, microsurgery, thoracic myelopathy, minimally invasive procedures