椎体終板石灰化を伴う胸椎椎間板ヘルニアに対する経皮的脊椎内視鏡下カバードライブ除圧術の治療

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 Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), and postoperative radiographic imaging (CT/MRI).

All procedures were completed without dural or thoracic nerve injury. Significant relief of thoracolumbar back pain and thoracic radicular pain was observed. Postoperative CT and MRI confirmed complete decompression of the thoracic spinal canal without residual compression. Final follow-up scores for VAS, JOA, and ODI 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.