Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of combined minimally invasive surgery forthe treatment of invasive vertebral hemangioma in the thoracic spine. [Methods] The patients received spinal artery angiography before sur-gery to understand the blood supply of the lesions in the spinal canal, and the blood supply artery was embolized by spring coil. The patientwas placed in prone position with fluoroscopic positioning performed. After local anesthesia, percutaneous puncture needles were insertedalong the pedicle to reach the target location of the vertebral body, and then a working channel was established. Disposable flexible bone ce-ment filling kit was inserted, and the bone cement was slowly pushed into the entire lesion aera under repeated fluoroscopy. In addition, thetransforaminal endoscope working channel was established under local anesthesia, and a trephine was inserted to enlarge and shape the foramina. The operating cannula was pushed into the posterior margin of the involved vertebra, the occupying tissue in the spinal canal was re-moved under the endoscope until the dural pulsation was observed. Finally, a drainage tube was placed and the wound was sutured. [Results]The patients got significant pain relief with VAS score of 0 postoperatively, while had muscle strength of the right lower limb recovered tograde 4 +. Images 1 week after surgery showed about 60% of intraspinal hemangioma removed, with obvious operative area exudation. Theremnant of hemangioma shrinked gradually 4 months after surgery compared with that preoperatively, no significant recurrence or increasewas observed, the spinal cord recovered significantly under compression, and the operative area exudation was completely absorbed. [Conclusion] This combined minimally invasive surgery provides a new idea and technique of the minimally invasive treatment for invasive verte-bral hemangioma in thoracic spine, and achieves satisfactory primary clinical outcome.