How i do it: biportal endoscopic thoracic decompression for ossification of the ligamentum flavum

Currently, decompressive laminectomy with or without concomitant fusion is a standard treatment for ossification of the ligamentum flavum (OLF). However, conventional thoracic decompressive laminectomy is not free of the inevitable destruction of the posterior ligamentous complex, and facet injury may lead to various sequelae.We used the biportal endoscopic technique for posterior thoracic decompression (BE-PTD) and describe the steps with discussion regarding the indications, advantages, possible complications, and ways to overcome complications.BE-PTD can obtain endoscopic visualizations of all the boundaries of the OLF lesion and achieve direct neural decompression of thoracic OLF.