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Updated: Jan 17, 2026
Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes
Published on: April 21, 2023
Innovative Approaches in Thoracic Surgery: Unilateral Biportal Endoscopy and 3D Printing in Managing Ligamentum
He-Qing Zhang1, Xiao-Guang Fan1, Lei-Sheng Wang1
1The Second Department of Spine Surgery, Yantaishan Hospital, Yantai City, Shandong Province, China.
Objective:
The objective of this study was to assess the clinical efficacy of unilateral biportal endoscopy technology in conjunction with three-dimensional (3D) printing technology for treating thoracic spinal stenosis caused by thoracic ligamentum flavum ossification (TOLF).
Methods:
A total of 21 patients diagnosed with TOLF through imaging who met surgical indications were selected. Demographic data, including sex, age, affected segments, etiological factors, operation duration, drainage volume, and postoperative complications, were documented. The modified Japanese Orthopaedic Association score was used to evaluate neurological function before and after the surgical intervention. Postoperative complications, including lower extremity deep vein thrombosis, neurological injury, cerebrospinal fluid leakage, and surgical site infection, were also recorded. Imaging studies, including computed tomography, magnetic resonance imaging, cross-sectional area of the spinal canal, and 3D printing models, were utilized to evaluate spinal cord compression and decompression outcomes.
Results:
Among the 21 patients, 15 underwent single-segment decompression, and 6 underwent double-segment decompression. The average operation time for single-segment decompression was 95 minutes, while double-segment decompression averaged 125 minutes. The average drainage volume was 48 mL for single-segment and 80 mL for double-segment procedures. Computed tomography, magnetic resonance imaging, cross-sectional area of the spinal canal, and 3D-printed models demonstrated a significant increase in the effective volume of the spinal canal. The average recovery rate at 1 year postsurgery for patients with simple TOLF was recorded at 70 ± 11%, while that for double-segment cases was 57 ± 9.4%. There were no instances of lower extremity deep vein thrombosis, neurological injury, or surgical site infection among the patients. Only 2 patients experienced postoperative cerebrospinal fluid leakage.
Conclusions:
Unilateral biportal endoscopy technology combined with 3D printing technology offers advantages such as minimal invasiveness, rapid recovery, and definite efficacy in the treatment of TOLF. This approach can significantly mitigate complications such as neurological deterioration.
