Ligamentum flavum hematoma (LFH) is a rare cause of spinal cord compression and is most frequently reported in the lumbar spine, while thoracic involvement is uncommon. Most previously reported thoracic LFH cases have been treated using conventional open decompression, and minimally invasive surgical techniques have rarely been described.

A 74-year-old female jazz dance instructor presented with severe thoracic back pain that developed after repetitive spinal extension and flexion movements during a dance lesson, followed by progressive numbness in both lower extremities. These symptoms significantly interfered with her professional activities. Neurological examination revealed no motor weakness or bladder dysfunction. Magnetic resonance imaging demonstrated a posterior epidural mass compressing the spinal cord at the T10–11 level, consistent with LFH. Because conservative treatment failed to improve symptoms, surgical decompression was performed using a microendoscopic decompression technique. A tubular retractor with an inner diameter of 16 mm was used to access the surgical site. The ligamentum flavum hematoma was clearly visualized and completely removed under endoscopic magnification. Adhesion between the ligamentum flavum and dura mater was observed but was safely dissected without dural injury. Histopathological examination confirmed ligamentum flavum hematoma. Postoperative imaging demonstrated complete spinal cord decompression, and the patient experienced significant neurological recovery, allowing her to resume normal daily activities.

This case demonstrates that microendoscopic decompression is a safe and effective minimally invasive surgical option for thoracic LFH, even in the presence of dural adhesion. This technique provides excellent visualization while minimizing surgical invasiveness and represents a promising alternative to conventional open surgery