• Raymond J Gardocki, Philip J Chandler, Wilson E Vaughan, Scott L Zuckerman, Amir M Abtahi, and Byron F Stephens.
• Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.
• Eur Spine J. 2023 Aug 1; 32 (8): 267926842679-2684.

Background And ImportanceTo describe the first case of a thoracic perineural cyst successfully treated using a direct thoracic transforaminal endoscopic approach.MethodsCase report.Clinical PresentationA 66-year-old male presented with right-sided radicular pain in a T4 distribution. MRI of the thoracic spine revealed a right T4 perineural cyst caudally displacing the root in the T4-5 foramen. He had failed attempts at nonoperative management. The patient underwent an all endoscopic transforaminal perineural cyst decompression and resection as a same-day surgical procedure. Postoperatively, the patient noted near complete resolution of the preoperative radicular pain. A thoracic MRI with and without contrast was performed 3 months after surgery and showed no evidence of the preoperative perineural cyst and no symptom recurrence was noted by the patient.ConclusionThis case report presents the first safe and successful report of an all endoscopic transforaminal decompression and resection of a perineural cyst in the thoracic spine.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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