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Abstract Objective〓To evaluate the safety and efficacy of percutaneous endoscopic unilateral laminectomy for bilateral decompression (Endo-ULBD) in the treatment of thoracic ossification of the ligamentum flavum (TOLF).Methods〓A retrospective analysis was conducted on 28 patients with TOLF admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to January 2023.Among them，14 patients underwent Endo-ULBD surgery，comprising 7 males and 7 females，with ages ranging from 50 to 73 years old and a mean age of (61.79±8.33)years.The remaining 14 patients received traditional posterior laminectomy or combined fusion and fixation surgery，including 10 males and 4 females，with ages spanning from 50 to 70 years old and a mean age of (60.57±6.10)years.Comparisons were made between the two patient groups regarding general baseline data，surgical duration，hospital stay，intraoperative blood loss，postoperative visual analogue scale(VAS) scores for pain，Japanese orthopaedic association(JOA) scores，activities of daily living (ADL) scores，Oswestry disability index(ODI) scores，and the incidence of complications.Results〓The comparison of intraoperative blood loss and hospital stay duration between the two groups revealed significant statistical differences (P＜0.05)，whereas the difference in operation time was not statistically significant (P＞0.05).The VAS，JOA，ADL，and ODI scores of both groups at 1 month，6 months postoperatively，and at the final follow-up did not exhibit statistically significant differences (P＞0.05).However，within each group，the comparison of these indicators across different time points showed statistical differences (P＜0.05).In the Endo-ULBD group，there were no complications such as cerebrospinal fluid leakage，epidural hematoma，spinal nerve function deterioration，nerve damage，or incision infection.In contrast，the traditional surgery group reported 2 cases (14.2%) of cerebrospinal fluid leakage and 1 case (7.1%) of postoperative headache and neck pain.Conclusion〓Endo-ULBD is an effective and safe surgical method for the treatment of TOLF，including cases with dural ossification，
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