A hybrid posterior microsurgical and lateral full-endoscopic approach for a large calcified thoracic disc herniation:...

Symptomatic thoracic disc herniations (TDHs) are uncommon but may result in significant neurological deficits. Established surgical approaches exhibit considerable complication rates, especially in the context of large, calcified, or central lesions. Minimally invasive options, including full-endoscopic transforaminal procedures, offer potential advantages but remain technically demanding and carry intrinsic risks.

A 36-year-old male presented with progressive myelopathy secondary to a large calcified herniation at T8-9. Due to suspected adhesion between the disc and dura mater-suggested by the absence of posterior spinal cord displacement on magnetic resonance imaging (MRI) despite a large ventral lesion-a hybrid surgical approach was employed, combining posterior microsurgical decompression and dural release (the "hammock technique") with transforaminal full-endoscopic disc removal. Controlled dural traction facilitated the safe dissection of adhesions, allowing for the effective removal of the herniation. The patient achieved substantial neurological recovery, with the modified Thoracic Japanese Orthopedic Association score (T-JOA) improving from 6 to 11 and restoration of motor, sensory, and bladder function within one month postoperatively, without complications.

This case highlights the feasibility of a novel hybrid open-endoscopic approach, utilizing controlled dural traction and mobilization, for treating complex TDHs with suspected ventral dural adhesion. The patient showed remarkable early neurological improvement, with the modified T-JOA score increasing from 6 to 11 within one month and no early complications. This hybrid technique shows promise in reducing neural manipulation and improving outcomes in challenging cases. However, longer-term follow-up is required to confirm sustained neurological outcomes and spinal stability. Further prospective studies with larger cohorts are needed to validate its efficacy and define its role in clinical practice.