Purpose <p>Complete resection of spinal cord tumors in the thoracic region requires precise preservation of critical vascular structures such as the Adamkiewicz artery. This report highlights the utility of narrow band imaging (NBI) in achieving complete schwannoma removal, while preserving vascular integrity.</p> Case presentation <p>A 72-year-old male presented with left lower extremity weakness persisting for four months. He experienced difficulty cycling uphill and was forced to walk in a forward-bent posture. MRI revealed a dumbbell-shaped mass extending from the intradural space at Th12/L1 into the paravertebral region, resulting in the diagnosis of schwannoma arising from the left Th12 nerve root. Preoperative computed tomography angiography indicated proximity of the Adamkiewicz artery to the tumor. Intraoperatively, NBI facilitated identification and preservation of the Adamkiewicz artery during tumor removal. Postoperatively, the patient’s muscle strength improved, and he resumed normal walking without forward bending posture.</p> Conclusions <p>NBI is a valuable adjunct for visualizing critical vascular structures intraoperatively, ensuring safe and effective tumor resection.</p>