Biportal Endoscopic Transforaminal Approach for Midthoracic Calcified Herniated Disc: A Case Report and Technical Note

Thoracic disc herniation is rare, and calcification occurs in up to 70% of symptomatic cases, making surgical treatment technically demanding because of the proximity of the spinal cord. Conventional open approaches often require extensive dissection and carry substantial risks of pulmonary complications. This report describes the successful use of a biportal endoscopic transforaminal approach for a calcified herniated disc at the midthoracic level. An 84-year-old woman presented with a 1-year history of chronic left flank pain. Magnetic resonance imaging and computed tomography revealed a left paracentral and foraminal calcified disc herniation at T6–7. Under spinal anesthesia, the lesion was removed using a biportal endoscopic transforaminal approach. On the basis of the demi-facet anatomy, in which the rib and disc are aligned, the surgical corridor was established approximately 2.5 cm lateral to the pedicle. The calcified disc material was removed without spinal cord retraction. Immediate postoperative pain relief was achieved, and the patient was discharged without complications on postoperative day 2. This case suggests that the biportal endoscopic transforaminal approach may be a feasible minimally invasive option for selected midthoracic calcified disc herniations. A precise understanding of the anatomical relationship between the rib and disc at the midthoracic level is essential for establishing a safe surgical trajectory without cord manipulation. This technique may expand the indications for biportal endoscopy to selected complex thoracic spine pathologies.