Transforaminal full-endoscopic thoracic foraminoplasty performed under local anesthesia for foraminal stenosis associated with degenerative scoliosis: illustrative case.

BACKGROUND: Thoracic foraminal stenosis is an uncommon but clinically important cause of thoracic radiculopathy and intercostal neuralgia. In adult degenerative scoliosis, asymmetric narrowing of the intervertebral foramen on the concave side of the curve can result in focal nerve root compression. Surgical management is challenging because of complex 3D anatomy and the invasiveness of conventional open procedures. OBSERVATIONS: The authors present the case of a patient with severe adult degenerative scoliosis (Cobb angle 60°) complicated by focal thoracic foraminal stenosis causing refractory intercostal neuralgia. The symptomatic level was identified by imaging studies and a selective nerve root block. Targeted decompression was performed using transforaminal full-endoscopic thoracic foraminoplasty under local anesthesia. Intraoperative endoscopic visualization demonstrated stepwise bony decompression, exposure of the exiting thoracic nerve root, and restoration of nerve root mobility within a deformed thoracic anatomy. The patient experienced immediate and sustained pain relief without neurological complications and was able to ambulate shortly after surgery. LESSONS: Transforaminal full-endoscopic thoracic foraminoplasty under local anesthesia enables direct visualization and safe decompression of the thoracic nerve root, even in the setting of severe scoliosis. This technique represents an effective minimally invasive alternative to extensive deformity correction in carefully selected patients with focal thoracic radiculopathy. https://thejns.org/doi/10.3171/CASE26145.