{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:51:56Z","timestamp":1769727116378,"version":"3.49.0"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,10,14]]},"abstract":"\n BACKGROUND<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n This article reports an unusual presentation of a 31-year-old male with thoracic myelopathy due to thoracic disc herniation (TDH) at the T8\u20139 level and ossification of the ligamentum flavum at the T10\u201311 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.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n 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.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24413<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24413","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T02:44:42Z","timestamp":1728873882000},"source":"Crossref","is-referenced-by-count":3,"title":["Multilevel thoracic myelopathy: full-endoscopic solution. Illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Sukumar","family":"Sura","sequence":"first","affiliation":[{"name":"Departments of Spine Surgery, Asian Spine Hospital, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harshit","family":"Dave","sequence":"additional","affiliation":[{"name":"Departments of Spine Surgery, Asian Spine Hospital, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhinandan","family":"Reddy Mallepally","sequence":"additional","affiliation":[{"name":"Departments of Spine Surgery, Asian Spine Hospital, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajendra","family":"Reddy","sequence":"additional","affiliation":[{"name":"Departments of Spine Surgery, Asian Spine Hospital, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. C. V","family":"Tulasi Ram","sequence":"additional","affiliation":[{"name":"Departments of Spine Surgery, Asian Spine Hospital, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Padma","family":"Ravikanti","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Asian Spine Hospital, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naresh","family":"Kumar Pagidimarry","sequence":"additional","affiliation":[{"name":"Spine Endoscopy Research Foundation (SERF), Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Clin Spine Surg","first-page":"86","article-title":"Clinical features of thoracic spinal stenosis-associated myelopathy: a retrospective analysis of 427 cases","volume":"29","author":"Hou","year":"2016","unstructured":"Hou XSun CLiu X, et al. Clinical features of thoracic spinal stenosis-associated myelopathy: a retrospective analysis of 427 cases. Clin Spine Surg. 2016;29(2):86-89."},{"issue":"7","key":"bib2","series-title":"Arch Orthop Trauma Surg","first-page":"903","article-title":"Neurological manifestations of thoracic myelopathy","volume":"134","author":"Takenaka","year":"2014","unstructured":"Takenaka SKaito THosono N, et al. Neurological manifestations of thoracic myelopathy. Arch Orthop Trauma Surg. 2014;134(7):903-912."},{"issue":"2","key":"bib3","series-title":"J Neurosurg Spine","first-page":"147","article-title":"Examination of the influence of ossification of the anterior longitudinal ligament on symptom progression and surgical outcome of ossification of the thoracic ligamentum flavum: a multicenter study","volume":"16","author":"Ando","year":"2012","unstructured":"Ando KImagama SWakao N, et al. Examination of the influence of ossification of the anterior longitudinal ligament on symptom progression and surgical outcome of ossification of the thoracic ligamentum flavum: a multicenter study. J Neurosurg Spine. 2012;16(2):147-153."},{"issue":"11","key":"bib4","series-title":"J Am Acad Orthop Surg Glob Res Rev","first-page":"e18.00090","article-title":"Clinical features of thoracic myelopathy: a single-center study","volume":"3","author":"Ando","year":"2019","unstructured":"Ando KImagama SKobayashi K, et al. Clinical features of thoracic myelopathy: a single-center study. J Am Acad Orthop Surg Glob Res Rev. 2019;3(11):e18.00090."},{"issue":"12","key":"bib5","series-title":"J Am Acad Orthop Surg","first-page":"e842","article-title":"Ossified ligamentum flavum: epidemiology, treatment, and outcomes","volume":"30","author":"Daniels","year":"2022","unstructured":"Daniels AHMcDonald CLBasques BAKuris EO. Ossified ligamentum flavum: epidemiology, treatment, and outcomes. J Am Acad Orthop Surg. 2022;30(12):e842-e851."},{"issue":"1","key":"bib6","series-title":"J Orthop Sci","first-page":"26","article-title":"Wnt signaling pathway correlates with ossification of the spinal ligament: a microRNA array and immunohistochemical study","volume":"23","author":"Yayama","year":"2018","unstructured":"Yayama TMori KOkumura N, et al. Wnt signaling pathway correlates with ossification of the spinal ligament: a microRNA array and immunohistochemical study. J Orthop Sci. 2018;23(1):26-31."},{"issue":"5","key":"bib7","series-title":"Glob Spine J","first-page":"1664","article-title":"Degenerative thoracic myelopathy: a scoping review of epidemiology, genetics, and pathogenesis","volume":"14","author":"Rujeedawa","year":"2024","unstructured":"Rujeedawa TMowforth ODDavies BM, et al. Degenerative thoracic myelopathy: a scoping review of epidemiology, genetics, and pathogenesis. Glob Spine J. 2024;14(5):1664-1677."},{"issue":"2","key":"bib8","series-title":"Surg Radiol Anat","first-page":"119","article-title":"Frequency and size of ossifications in the caudal attachments of the ligamentum flavum of the thoracic spine. Role of rotatory strains in their development. An anatomic study of 121 spines","volume":"14","author":"Maigne","year":"1992","unstructured":"Maigne JYAyral XGu\u00e9rin-Surville H. Frequency and size of ossifications in the caudal attachments of the ligamentum flavum of the thoracic spine. Role of rotatory strains in their development. An anatomic study of 121 spines. Surg Radiol Anat. 1992;14(2):119-124."},{"issue":"3","key":"bib9","series-title":"J Neurosurg","first-page":"251","article-title":"Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine","volume":"99","author":"Miyakoshi","year":"2003","unstructured":"Miyakoshi NShimada YSuzuki T, et al. Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg. 2003;99(3suppl):251-256."},{"issue":"3","key":"bib10","series-title":"Spinal Cord","first-page":"188","article-title":"Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases","volume":"54","author":"Li","year":"2016","unstructured":"Li ZRen DZhao Y, et al. Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases. Spinal Cord. 2016;54(3):188-196."},{"issue":"4","key":"bib11","series-title":"Eur Spine J","first-page":"857","article-title":"Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases","volume":"22","author":"Lang","year":"2013","unstructured":"Lang NYuan HSWang HL, et al. 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StatPearls Publishing; 2024."},{"issue":"6","key":"bib14","series-title":"J Spinal Disord Tech","first-page":"492","article-title":"Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options","volume":"18","author":"Matsuyama","year":"2005","unstructured":"Matsuyama YYoshihara HTsuji T, et al. Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options. J Spinal Disord Tech. 2005;18(6):492-498."},{"issue":"7","key":"bib15","series-title":"Spinal Cord","first-page":"362","article-title":"Surgical treatment for thoracic spinal stenosis","volume":"39","author":"Chang","year":"2001","unstructured":"Chang UKChoe WJChung CKKim HJ. Surgical treatment for thoracic spinal stenosis. 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World Neurosurg. 2016;90:194-198."},{"issue":"1","key":"bib22","series-title":"Egypt J Neurosurg","first-page":"24","article-title":"Thoracic endoscopic surgery: advantages and limitations","volume":"38","author":"Nagy","year":"2023","unstructured":"Nagy MR. Thoracic endoscopic surgery: advantages and limitations. Egypt J Neurosurg. 2023;38(1):24."},{"issue":"4","key":"bib23","series-title":"J Spinal Disord Tech","first-page":"222","article-title":"Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications","volume":"26","author":"Lubelski","year":"2013","unstructured":"Lubelski DAbdullah KGSteinmetz MP, et al. Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications. J Spinal Disord Tech. 2013;26(4):222-232."},{"issue":"1","key":"bib24","series-title":"Neurospine","first-page":"24","article-title":"A review of minimally invasive surgical techniques for the management of thoracic disc herniations","volume":"16","author":"Sharma","year":"2019","unstructured":"Sharma SBKim JS. A review of minimally invasive surgical techniques for the management of thoracic disc herniations. Neurospine. 2019;16(1):24-33."},{"key":"bib25","series-title":"BioMed Res Int","first-page":"8345736","article-title":"Full endoscopic surgery for thoracic pathology: next step after mastering lumbar and cervical endoscopic spine surgery?","volume":"2022","author":"Bae","year":"2022","unstructured":"Bae JLee SHWagner RShen JTelfeian AE. Full endoscopic surgery for thoracic pathology: next step after mastering lumbar and cervical endoscopic spine surgery?BioMed Res Int. 2022;2022:8345736."},{"issue":"2","key":"bib1","series-title":"Clin Spine Surg","first-page":"86","article-title":"Clinical features of thoracic spinal stenosis-associated myelopathy: a retrospective analysis of 427 cases","volume":"29","author":"Hou","year":"2016","unstructured":"Hou XSun CLiu X, et al. Clinical features of thoracic spinal stenosis-associated myelopathy: a retrospective analysis of 427 cases. Clin Spine Surg. 2016;29(2):86-89."},{"issue":"7","key":"bib2","series-title":"Arch Orthop Trauma Surg","first-page":"903","article-title":"Neurological manifestations of thoracic myelopathy","volume":"134","author":"Takenaka","year":"2014","unstructured":"Takenaka SKaito THosono N, et al. Neurological manifestations of thoracic myelopathy. Arch Orthop Trauma Surg. 2014;134(7):903-912."},{"issue":"2","key":"bib3","series-title":"J Neurosurg Spine","first-page":"147","article-title":"Examination of the influence of ossification of the anterior longitudinal ligament on symptom progression and surgical outcome of ossification of the thoracic ligamentum flavum: a multicenter study","volume":"16","author":"Ando","year":"2012","unstructured":"Ando KImagama SWakao N, et al. Examination of the influence of ossification of the anterior longitudinal ligament on symptom progression and surgical outcome of ossification of the thoracic ligamentum flavum: a multicenter study. J Neurosurg Spine. 2012;16(2):147-153."},{"issue":"11","key":"bib4","series-title":"J Am Acad Orthop Surg Glob Res Rev","first-page":"e18.00090","article-title":"Clinical features of thoracic myelopathy: a single-center study","volume":"3","author":"Ando","year":"2019","unstructured":"Ando KImagama SKobayashi K, et al. Clinical features of thoracic myelopathy: a single-center study. J Am Acad Orthop Surg Glob Res Rev. 2019;3(11):e18.00090."},{"issue":"12","key":"bib5","series-title":"J Am Acad Orthop Surg","first-page":"e842","article-title":"Ossified ligamentum flavum: epidemiology, treatment, and outcomes","volume":"30","author":"Daniels","year":"2022","unstructured":"Daniels AHMcDonald CLBasques BAKuris EO. Ossified ligamentum flavum: epidemiology, treatment, and outcomes. J Am Acad Orthop Surg. 2022;30(12):e842-e851."},{"issue":"1","key":"bib6","series-title":"J Orthop Sci","first-page":"26","article-title":"Wnt signaling pathway correlates with ossification of the spinal ligament: a microRNA array and immunohistochemical study","volume":"23","author":"Yayama","year":"2018","unstructured":"Yayama TMori KOkumura N, et al. Wnt signaling pathway correlates with ossification of the spinal ligament: a microRNA array and immunohistochemical study. J Orthop Sci. 2018;23(1):26-31."},{"issue":"5","key":"bib7","series-title":"Glob Spine J","first-page":"1664","article-title":"Degenerative thoracic myelopathy: a scoping review of epidemiology, genetics, and pathogenesis","volume":"14","author":"Rujeedawa","year":"2024","unstructured":"Rujeedawa TMowforth ODDavies BM, et al. Degenerative thoracic myelopathy: a scoping review of epidemiology, genetics, and pathogenesis. Glob Spine J. 2024;14(5):1664-1677."},{"issue":"2","key":"bib8","series-title":"Surg Radiol Anat","first-page":"119","article-title":"Frequency and size of ossifications in the caudal attachments of the ligamentum flavum of the thoracic spine. Role of rotatory strains in their development. An anatomic study of 121 spines","volume":"14","author":"Maigne","year":"1992","unstructured":"Maigne JYAyral XGu\u00e9rin-Surville H. Frequency and size of ossifications in the caudal attachments of the ligamentum flavum of the thoracic spine. Role of rotatory strains in their development. An anatomic study of 121 spines. Surg Radiol Anat. 1992;14(2):119-124."},{"issue":"3","key":"bib9","series-title":"J Neurosurg","first-page":"251","article-title":"Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine","volume":"99","author":"Miyakoshi","year":"2003","unstructured":"Miyakoshi NShimada YSuzuki T, et al. Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg. 2003;99(3suppl):251-256."},{"issue":"3","key":"bib10","series-title":"Spinal Cord","first-page":"188","article-title":"Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases","volume":"54","author":"Li","year":"2016","unstructured":"Li ZRen DZhao Y, et al. Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases. Spinal Cord. 2016;54(3):188-196."},{"issue":"4","key":"bib11","series-title":"Eur Spine J","first-page":"857","article-title":"Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases","volume":"22","author":"Lang","year":"2013","unstructured":"Lang NYuan HSWang HL, et al. Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases. Eur Spine J. 2013;22(4):857-862."},{"key":"bib12","series-title":"World Neurosurg","first-page":"e517","article-title":"Prevalence and distribution of incidental thoracic disc herniation, and thoracic hypertrophied ligamentum flavum in patients with back or leg pain: a magnetic resonance imaging-based cross-sectional study","volume":"120","author":"Han","year":"2018","unstructured":"Han SJang IT. Prevalence and distribution of incidental thoracic disc herniation, and thoracic hypertrophied ligamentum flavum in patients with back or leg pain: a magnetic resonance imaging-based cross-sectional study. World Neurosurg. 2018;120:e517-e524."},{"key":"bib13","series-title":"StatPearls","article-title":"Thoracic discogenic syndrome","author":"Fogwe","year":"2024","unstructured":"Fogwe DTPetrone BMunakomi SMesfin FB. Thoracic discogenic syndrome. In: StatPearls. Internet. StatPearls Publishing; 2024."},{"issue":"6","key":"bib14","series-title":"J Spinal Disord Tech","first-page":"492","article-title":"Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options","volume":"18","author":"Matsuyama","year":"2005","unstructured":"Matsuyama YYoshihara HTsuji T, et al. Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options. J Spinal Disord Tech. 2005;18(6):492-498."},{"issue":"7","key":"bib15","series-title":"Spinal Cord","first-page":"362","article-title":"Surgical treatment for thoracic spinal stenosis","volume":"39","author":"Chang","year":"2001","unstructured":"Chang UKChoe WJChung CKKim HJ. Surgical treatment for thoracic spinal stenosis. Spinal Cord. 2001;39(7):362-369."},{"issue":"1","key":"bib16","series-title":"J Neurosurg Spine","first-page":"13","article-title":"Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients","volume":"7","author":"Aizawa","year":"2007","unstructured":"Aizawa TSato TSasaki H, et al. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J Neurosurg Spine. 2007;7(1):13-20."},{"issue":"8","key":"bib17","series-title":"Spine J","first-page":"1654","article-title":"Anterior or posterior approach of thoracic disc herniation? A comparative cohort of mini-transthoracic versus transpedicular discectomies","volume":"14","author":"Arts","year":"2014","unstructured":"Arts MPBartels RH. Anterior or posterior approach of thoracic disc herniation? A comparative cohort of mini-transthoracic versus transpedicular discectomies. Spine J. 2014;14(8):1654-1662."},{"issue":"22","key":"bib18","series-title":"Case Rep Med (Baltimore)","first-page":"e15541","article-title":"Full-endoscopic interlaminar discectomy for the treatment of a dorsal migrated thoracic disc herniation: case report","volume":"98","author":"Hur","year":"2019","unstructured":"Hur JWKim JSSeung JH. Full-endoscopic interlaminar discectomy for the treatment of a dorsal migrated thoracic disc herniation: case report. Case Rep Med (Baltimore). 2019;98(22):e15541."},{"issue":"1","key":"bib19","series-title":"Asian Spine J","first-page":"89","article-title":"Ossification of the ligamentum flavum","volume":"8","author":"Ahn","year":"2014","unstructured":"Ahn DKLee SMoon SHBoo KHChang BKLee JI. Ossification of the ligamentum flavum. 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World Neurosurg. 2016;90:194-198."},{"issue":"1","key":"bib22","series-title":"Egypt J Neurosurg","first-page":"24","article-title":"Thoracic endoscopic surgery: advantages and limitations","volume":"38","author":"Nagy","year":"2023","unstructured":"Nagy MR. Thoracic endoscopic surgery: advantages and limitations. Egypt J Neurosurg. 2023;38(1):24."},{"issue":"4","key":"bib23","series-title":"J Spinal Disord Tech","first-page":"222","article-title":"Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications","volume":"26","author":"Lubelski","year":"2013","unstructured":"Lubelski DAbdullah KGSteinmetz MP, et al. Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications. 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