Thoracic Unilateral Laminetomy for Bilateral Decompression by Unilateral Biportal Endoscopy

Unilateral biportal endoscopy (UBE) is a minimally invasive endoscopic spine surgery that is currently used to operate degenerative spinal diseases involving the cervical, lumbar, and thoracic spine. The application of unilateral laminectomy for bilateral decompression (ULBD) by UBE is also being tried in treating thoracic spinal stenosis or ossified ligamentum flavum (OLF). Thoracic ULBD by UBE can decrease postoperative instability and back pain by preserving the contralateral facet joint, lamina, and musculoligamentous structures. Also, the main advantage of this technique lies in the availability of a clear and magnified surgical view during operation under endoscopy with continuous saline irrigation. Since excessive compression of the spinal cord by surgical instruments may lead to spinal cord injury, securing space for safe surgery is of utmost importance in thoracic spine surgery. In this chapter, we discuss the common indications for thoracic ULBD by UBE and the surgical techniques and tips for this procedure. We also focus on specific anatomical landmarks to highlight complication avoidance.