J Neurosurg Spine 42:775–783, 2025
The trans-superior articular process (SAP) approach for endoscopic thoracic discectomy enables safe, minimally invasive treatment of symptomatic thoracic disc herniation, particularly in challenging upper/mid-thoracic regions, with significant improvements in pain and disability, short operative time, and low complication rates in a 38-patient series.
• Trans-superior articular process (trans-SAP) approach for endoscopic thoracic discectomy is described for symptomatic thoracic disc herniation (TDH).
• This technique creates a controlled corridor through the SAP using a Jamshidi needle and manual bone drills, minimizing facet removal and neural injury.
• Study included 38 patients (mean age 48.9), mostly with central or middle thoracic herniations.
• Mean operative time was 42 minutes, hospital stay 1.3 days, and follow-up 11.5 months.
• Significant improvements in pain (VAS) and disability (ODI) scores were observed at all follow-up points.
• Only one complication (2.6%, recurrent herniation) was reported.
• Trans-SAP approach is safe, effective, and minimally invasive, but has a steep learning curve and is not suitable for hard disc, severe myelopathy, or ossified ligament cases.
• Technique enables treatment of central and paramedian TDH and can be performed under local anesthesia.
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