Calcified Thoracic Disc Herniation: Surgical Management, Surgical Approaches, and Decision-Making.

Calcified thoracic disc herniation is an uncommon but clinically important spinal pathology that may cause progressive myelopathy, neurological deterioration, and complex ventral spinal cord compression. Compared with non-calcified thoracic disc disease, calcified lesions are often more rigid, centrally located, and adherent to the dura, making surgical management technically demanding. Although anterior, anterolateral, posterolateral, minimally invasive, and endoscopic approaches have all been described, no universally accepted surgical strategy exists. Approach selection remains dependent on lesion morphology, degree of calcification, canal compromise, neurological status, patient comorbidity, and surgeon experience. This narrative review summarizes the current evidence on surgical management of calcified thoracic disc herniation, with emphasis on preoperative evaluation, decision-making variables, indications, limitations, and outcomes of the major operative corridors. Central, giant, densely calcified lesions may favor anterior or anterolateral access for direct ventral decompression, whereas paracentral or lateral lesions may be suitable for posterolateral, minimally invasive, or endoscopic approaches in selected patients. Emerging evidence suggests that posterior and endoscopic techniques may also be feasible in more complex calcified lesions when performed by experienced surgeons. Optimal management should therefore be individualized, balancing adequate neural decompression with approach-related morbidity and the technical capabilities of the treating team.