Treatment of Calcified Thoracic Disc Herniation by Percutaneous Spinal Endoscopy with Culvert Decompression

To evaluate the surgical approach, clinical efficacy, and safety of percutaneous spinal endoscopic "culvert decompression" in treating calcified thoracic disc herniation (TDH).

Four patients with calcified TDH underwent percutaneous endoscopic posterolateral decompression using the culvert decompression technique. Calcified disc material was incrementally removed in a controlled manner. Clinical outcomes were assessed using the Visual Analog Scale, Japanese Orthopaedic Association score, Oswestry Disability Index, and postoperative radiographic imaging (computed tomography/magnetic resonance imaging).

All procedures were completed without dural or thoracic nerve injury. Significant relief of thoracolumbar back pain and thoracic radicular pain was observed. Postoperative computed tomography and magnetic resonance imaging confirmed complete decompression of the thoracic spinal canal without residual compression. Final follow-up scores for Visual Analog Scale, Japanese Orthopaedic Association, and Oswestry Disability Index showed statistically and clinically significant improvements compared with preoperative values.

The culvert decompression technique adheres to a "from anterior to posterior, from outside to inside" principle. Sequential drilling of bone and disc tissue from the posterior vertebral body extends toward the anterior dural space near the midline. This stepwise decompression maximizes buffer space and minimizes dural irritation-particularly beneficial in cases with dural adhesions. Thus, this minimally invasive percutaneous spinal endoscopic method appears to be a safe and feasible option for calcified TDH.