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Endoscopic Trans-Costovertebral Approach to Thoracic Discectomy for Central Calcified Disc Herniations: A Technical
Dorian Mambelli1, Audrey Demand1, Samuel B Kankam1
1Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas USA.
World Neurosurgery
|February 18, 2026
Summary
Endoscopic trans-costovertebral (eTCV) surgery provides a minimally invasive option for challenging thoracic disc herniations (TDH). This technique offers a safe corridor for resecting large, calcified TDH, improving patient outcomes.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
Background:
- Thoracic disc herniations (TDH) are rare but can cause severe myelopathy.
- Ventral TDH present surgical challenges due to their location and limited operative corridors.
Purpose of the Study:
- To evaluate the efficacy of an endoscopic trans-costovertebral (eTCV) approach for managing a large, centrally located, calcified thoracic disc herniation.
Main Methods:
- A 46-year-old male with progressive gait instability underwent surgery for a T5-6 disc herniation.
- An endoscopic trans-costovertebral (eTCV) approach was utilized due to the ventral cord compression and calcified nature of the herniation.
Main Results:
- The eTCV approach provided safe access to the ventral thoracic pathology.
- Successful resection of the large, centrally located, calcified T5-6 disc herniation was achieved.
Conclusions:
- The endoscopic trans-costovertebral (eTCV) approach is an effective minimally invasive corridor for resecting large, centrally located, calcified TDH.
- Key technical considerations include entry point selection, rib anatomy identification, and foraminoplasty under endoscopic visualization.
