Multilevel thoracic myelopathy: full-endoscopic solution. Illustrative case.

Background: Thoracic myelopathy is relatively uncommon but, when present, causes significant disability. Early surgical intervention is often recommended for patients with myelopathy with compression at multiple levels. Surgical approaches and techniques for thoracic myelopathy have evolved from traditional open spine surgery to less invasive full-endoscopic spine surgery.

Observations: This article reports an unusual presentation of a 31-year-old male with thoracic myelopathy due to thoracic disc herniation (TDH) at the T8-9 level and ossification of the ligamentum flavum at the T10-11 level that was managed using full-endoscopic spine surgery techniques in a single sitting. The presence of coexisting spinal disorders, that is, TDH and ossification of the posterior longitudinal ligament at noncontiguous spinal levels, makes surgical decision-making more complicated.

Lessons: Uniportal full-endoscopic spine surgery is a safe and effective surgical technique even for thoracic myelopathy. It is less invasive with minimal tissue and bone damage, better access to and visualization of the pathology, and minimal cord handling and is performed through small windows without destabilizing the spine, thus avoiding fusion. Anterior thoracic pathologies are better addressed through the transforaminal approach, whereas the interlaminar approach is preferred for posterior pathologies. Both of these approaches are complementary to each other with their own indications and advantages. https://thejns.org/doi/10.3171/CASE24413.