Full-endoscopic resection of a thoracic facet joint osteoblastoma: A case report

Introduction: Osteoblastoma is a benign osteoid-forming tumor that often arises from the posterior spinal elements. Thoracic facet-joint involvement is uncommon, and open resection may require extensive soft-tissue dissection and threaten segmental stability. Full-endoscopic resection may reduce morbidity; however, its use for thoracic facet osteoblastoma has not previously been reported. Research question: Can full-endoscopic surgery achieve gross-total resection of a small, facet-centered thoracic osteoblastoma while preserving neurologic function and spinal stability? Materials and methods: We report a 26-year-old woman with 2 years of upper thoracic pain radiating to the anterior chest wall. MRI showed a right T4-T5 facet lesion with reactive paravertebral edema and no epidural extension or cord compression. CT confirmed a well-circumscribed 10 × 11 mm lytic lesion centered at the right T4-T5 facet joint and extending toward the T5 transverse process. Full-endoscopic posterior resection was performed through a 10-mm incision using endoscopic burrs and punches, with stepwise drilling to a circumferential bleeding bony boundary. Results: Histopathology confirmed osteoblastoma. The patient had immediate pain relief, mobilized on the day of surgery, and was discharged the next day without neurologic deficit. One-month CT demonstrated complete resection with no residual lesion. At 3 months, she remained pain-free with no new complaints. Discussion and conclusion: Full-endoscopic excision enabled gross-total resection and rapid recovery in this facet-centered thoracic osteoblastoma. Careful selection, precise localization, and controlled resection may achieve complete local tumor removal while limiting soft-tissue disruption and avoiding early radiographic or clinical evidence of instability.