A 60-year-old male presented to the emergency department with acute onset paraplegia of the lower extremities of 1-day duration. Physical examination revealed muscle strength grade 0/5 in both lower limbs, impaired pain sensation below the umbilical level, diminished knee and ankle reflexes, and negative pathological signs. Thoracic spine magnetic resonance imaging (MRI) with and without contrast revealed an epidural cystic lesion at the T7-T8 level. Computed tomography (CT) findings were unremarkable. The patient underwent arthroscopic-assisted uniportal spinal surgery under general anesthesia through a 1.5 cm skin incision. A high-speed drill was used to perform a laminotomy involving the lower two-thirds of the T7 lamina and the upper edge of the T8 lamina, preserving approximately half of the inferior articular process laterally and exposing the base of the spinous process medially. Under endoscopic visualization, the cranial, caudal, and lateral margins of the soft tissue mass were identified. A neural dissector was used to separate the dura mater from the lesion. During dissection, the mass ruptured, discharging yellowish-white flocculent material. The lesion was completely resected, achieving satisfactory decompression of the neural elements. Histopathological examination revealed fibrofatty tissue containing amorphous eosinophilic deposits surrounded by chronic granulomatous inflammation, consistent with a gouty tophus. At three-month follow-up, the patient's lower limb muscle strength had improved to grade 3/5, enabling ambulation with crutches. Spinal epidural gouty tophi causing acute paraplegia are exceedingly rare. This case demonstrates clear endoscopic visualization of urate crystals and the associated tophus, with satisfactory postoperative outcome following uniportal spinal resection. To our knowledge, this represents the first reported case of a thoracic spinal epidural gouty tophus managed with endoscopic spine surgery.