A Two-Handed Technique in Biportal Endoscopic Spine Surgery Using an Endoscopic Self-Retractor for Resection of Ossification of Ligamentum Flavum in Thoracic Spine.

OBJECTIVE: Biportal endoscopic spine surgery commonly employs a single-handed technique despite the presence of dual portals. An endoscopic self-retractor attached to the viewing trocar enables true bimanual manipulation. The adoption of this 2-handed technique enables safer, more effective resection of the thoracic ossification of the ligamentum flavum (OLF).

METHODS: We describe the surgical method of the bimanual biportal endoscopic approach and its clinical application. A 74-year-old woman presented with bilateral leg weakness, radiating pain, and paresthesia. Preoperative magnetic resonance imaging revealed severe T11-T12 spinal cord compression due to OLF. She underwent decompression using the 2-handed biportal endoscopic technique. An endoscopic self-retractor mounted on the viewing portal trocar facilitated soft-tissue dissection and safe separation of the ossified ligamentum flavum (OLF) from the dura, enabling circumferential decompression through stepwise laminotomy, medial facetectomy, and controlled drilling under continuous saline irrigation. This technique allowed effective bilateral OLF removal while minimizing direct manipulation of the dura or spinal cord.

CONCLUSION: The use of an endoscopic self-retractor for 2-handed manipulation enhances surgical precision and facilitates safer, more effective OLF removal. This technique improves control and safety during complex thoracic decompression.

STUDY DESIGN: Technical note.