Combined Paramedian and Posterolateral Endoscopic Approach to Calcified Central Thoracic Herniation

 Thoracic endoscopic discectomy is gaining more popularity. Accessing the thoracic spine through a small skin incision rather than large exposures required for the traditional costotrasversectomy approach, the endoscopic technique alleviates pain and neurological symptoms and improves patient outcomes by targeting the compressive pathology directly. In this chapter, the author reviews the indications for the procedure, the inclusion and exclusion criteria, and its technical caveats by illustrating the application of endoscopic instruments and visualization systems. Preoperative evaluation, including advanced imaging techniques, is crucial for accurate diagnosis and surgical planning. Further, the author demonstrates the procedure's advantages, such as reduced tissue trauma, decreased blood loss, shorter hospital stays, and faster recovery than traditional open surgery. With appropriate patient selection and skilled surgical expertise, thoracic endoscopic discectomy is capable of managing thoracic disc herniation with comparable clinical outcomes compared to open techniques without collateral tissue trauma.