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All the cases were operated by a single surgeon by a posterior-only approach. We have used this technique in four patients with thoracic myelopathy due to combined or predominant anterior pathology. Postoperative imaging confirmed adequate decompression of the spinal cord. All the cases improved substantially in terms of clinical outcome. This surgical technique could be a useful alternative to direct anterior decompression in patients who present with symptoms of progressive severe myelopathy due to anterior compression and could be the