A Facet-Preserving Modified Transpedicular Approach Using Unilateral Biportal Endoscopy for Thoracic Spinal Pathology

This study aimed to describe a facet-preserving modified transpedicular unilateral biportal endoscopic (UBE) approach for upwardly migrated thoracic disc herniation that allows safe decompression without spinal cord retraction or postoperative instability. Thoracic disc herniation is rare but often symptomatic, producing myelopathy that typically necessitates surgical intervention. Because of the spinal cord’s close proximity, traditional discectomy approaches carry a high risk of neural injury, and achieving complete disc removal without cord manipulation remains a significant surgical challenge. Although several techniques have been proposed, many are limited by the potential for incomplete decompression or iatrogenic instability. A facet-preserving modified transpedicular UBE approach may overcome these limitations by offering a minimally invasive surgical corridor while maintaining spinal stability. A 76-year-old woman presented with progressive bilateral lower extremity weakness and numbness over 6 months, with rapid deterioration during the past month. Magnetic resonance imaging (MRI) revealed an upwardly migrated thoracic disc herniation at T10–11 compressing the spinal cord. A UBE discectomy using a facet-preserving modified transpedicular approach was performed. The herniated fragment was completely removed without spinal cord retraction. Postoperatively, the patient demonstrated neurological improvement without complications. MRI confirmed complete decompression of the cord, and computed tomography verified preservation of the facet joint. This video article introduces the modified transpedicular UBE approach as a safe and precise minimally invasive technique for thoracic ventral pathologies. By enabling direct ventral decompression while preserving spinal stability, it broadens the scope of endoscopic spine surgery and warrants further clinical validation.