Full-endoscopic lateral laminectomy on both sides with central line preservation under local anesthesia with monitored anesthesia care for thoracic spinal stenosis in a very old patient unsuitable for general anesthesia: illustrative case.

BACKGROUND: Thoracic spinal stenosis (TSS) is an uncommon but potentially debilitating condition that typically requires surgical decompression under general anesthesia, often with concomitant instrumented fusion. However, this approach poses substantial risks for patients who are very old or medically frail. The feasibility of full-endoscopic thoracic decompression under local anesthesia has not been well described. OBSERVATIONS: A 91-year-old man who presented with myelopathy caused by TSS at T11-12 and severe cardiac comorbidities underwent full-endoscopic transforaminal lateral thoracic laminectomy with discectomy on both sides under local anesthesia with monitored anesthesia care (MAC). The procedures were performed in a staged manner, with separate operations on each side to improve safety and tolerability. The technique enabled circumferential decompression while preserving the posterior midline supporting structures. Neurological improvement was achieved without perioperative complications. Postoperative imaging confirmed adequate decompression, and early mobilization was possible. LESSONS: Full-endoscopic lateral laminectomy on both sides with central line preservation under local anesthesia with MAC is a feasible and minimally invasive option for very old patients and those who are not suitable candidates for general anesthesia. Preservation of posterior stabilizing structures may reduce the risk of postoperative instability or kyphotic deformity. https://thejns.org/doi/10.3171/CASE26429.