Unilateral Biportal Endoscopic Transforaminal Approach for Chronic Central Thoracic Disc Herniation: A Video Case Report and Surgical Technique Description

To demonstrate the feasibility and highlight key technical nuances of a unilateral biportal endoscopic (UBE) transforaminal approach for resecting chronic, centrally calcified thoracic disc herniation (TDH). Central TDH is a rare and technically demanding condition due to the narrow thoracic canal, proximity to the spinal cord, and frequent calcification in chronic cases. Minimally invasive techniques that reduce spinal cord manipulation and preserve posterior stabilizing structures are therefore preferred. A 74-year-old woman presented with lower back and left leg pain, sensory disturbance, and gait impairment. Magnetic resonance imaging revealed a centrally calcified TDH at T10–11 with significant spinal cord compression. The lesion was approached via a transforaminal UBE route under continuous irrigation, providing a direct lateral working corridor for optimal visualization and controlled decompression. The calcified and adherent disc was progressively thinned and delicately dissected from the dura using an angled sharp hook and fine endoscopic instruments, minimizing cord manipulation. Postoperative imaging confirmed complete decompression, and the patient showed marked neurological recovery without complications. For centrally located, calcified TDH, the transforaminal UBE approach enables effective decompression while minimizing spinal cord retraction and preserving posterior elements. The accompanying video provides a detailed step-by-step demonstration of the procedure to enhance its safety and reproducibility.