Technical report: endoscopic approaches to the thoracic spine - transforaminal and interlaminar.

Endoscopic spine surgery has gained prominence as a minimally invasive alternative to traditional open procedures [1,2,4], particularly in managing thoracic spine pathology. The choice of approach-transforaminal or interlaminar-depends on the pathology, anatomical constraints, and surgical goals [3]. This report outlines a case of endoscopic interlaminar and transforaminal access for thoracic decompression. A 68-year-old retired female presented with a 12-month history of progressive myelopathy due to severe T10/11 spinal stenosis and ligamentum flavum hypertrophy. MRI revealed significant cord compression and cord signal change on T2WI. The patient was placed in the prone position under general anaesthesia. A midline 10-mm skin incision was made at T10/11, and a working cannula was inserted at the interlaminar window, targeting the inferior aspect of the T10 lamina. Under direct endoscopic visualization (10 mm Stenosis Scope, 7.1 mm Working Channel, Elliquence USA) the inferior T10 lamina was drilled to reveal the superior attachment of the ligamentum flavum insertion. The ipsilateral hypertrophic ligamentum flavum was resected using endoscopic Kerrison rongeurs and drill. An "over the top" technique was used to decompress the contralateral side (See Video) Decompression was confirmed by direct visualization of the dura and thecal sac pulsation. The patient experienced significant improvement in lower extremity function during the postoperative phase. She was mobilized on postoperative day 1 and discharged home on day 2 with continued outpatient rehabilitation. At 3-month follow-up, she demonstrated sustained neurological improvement. Thoracic endoscopic techniques minimize tissue disruption, facilitate rapid recovery, and expand the surgical armamentarium for thoracic spine pathology, without the requirement for fixation / stabilization. The authors propose that endoscopic techniques should become the mainstay of thoracic decompression without the need for more invasive techniques such as fixation and fusion.