The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results

Abstract

The purpose of the current study was to introduce a surgical technique for posterior cervical inclinatory foraminotomy (PCIF) using a percutaneous biportal endoscopic (BE) approach. Consecutive 7 patients underwent BE-PCIF for their cervical radiculopathy. Postoperative radiologic images (x-rays, computed tomography [CT], and magnetic resonance imaging [MRI]) were evaluated postoperatively for optimal neural decompression status and stability. A visual analogue scale (VAS) for the arm pain and the Neck Disability Index were used to evaluate clinical results in the preoperative and postoperative periods. Mean follow-up periods were 6.42 ± 2.99 months. The mean operative time was 101.42 ± 49.30 minutes. Postoperative MRI and CT revealed complete removal of herniated discs and ideal neural decompression of the treated segments in all patients. Disc height and stability were preserved on postoperative x-rays. Preoperative VAS and Oswestry Disability Index scores improved significantly after the surgery. BE-PCIF may be an effective surgical treatment of the cervical radiculopathic lesions, which provides successful surgical decompression as far as distal part of foramen with better operative view and more easy surgical manipulation. This approach may also minimize iatrogenic damages of the posterior cervical musculo-ligamentous structures and help to maximize the preservation of the facet joint.

Comparative Analysis of 3 Types of Minimally Invasive Posterior Cervical Foraminotomy for Foraminal Stenosis, Uniportal-, Biportal Endoscopy, and Microsurgery: Radiologic and Midterm Clinical Outcomes

“…Zdeblick et al [ 17 ] reported that instability slightly increased with a facet resection rate of up to 50%, but markedly increased with a facet resection rate of 75%. Chang et al [ 18 ] and Song and Lee [ 12 ] reported that undercutting the facet joint via an inclinatory surgical route is essential in terms of preserving the facet joint and capsule [ 12 , 18 ], further reporting favorable clinical outcomes. The 2 endoscopy groups in this study utilized a higher inclination angle when undercutting the facet joint and subsequently preserved the facet joint better than the microscopy group.…”

“…Furthermore, uniportal endoscopy with a 12° endoscopic view can reveal the deeper foraminal space even if the preserved facet joint interferes with the surgical viewing compared to biportal endoscopy with a zero-degree endoscopic view. Although biportal endoscopic and microscopic surgery can achieve cervical posterior inclinatory foraminotomy using the contralateral-sided endoscopic approach [ 12 ] and anterior cervical retractor system [ 18 ], respectively, ipsilateral-sided conventional surgeries might have less ability to make a higher inclinatory surgical route than uniportal endoscopic surgery. Making an inclinatory surgical route is challenging during microscopic PCF because the spinous process restricts the direction of resection, and almost all patients had a nearly vertical approach angle when using this technique (mean negative SFAA, -1.0°±1.7°).…”

“…Recently, biportal endoscopic surgery has been widely performed with developed surgical techniques to treat cervical radiculopathy as well as central canal stenosis. [12][13][14] However, no study has compared the clinical outcomes or radiologic results characterizing the change of the foraminal space and facet joint among the three types of MIS PCF in a single center. In addition, there are few studies on whether endoscopic PCF can achieve complete neural decompression rates similar to microscopic PCF.…”

“…A meta-analysis by Wu et al [ 11 ] revealed that both full endoscopic PCF and microscopic PCF offered equivalent clinical success rates, complication rates, and reoperation rates for cervical radiculopathy treatment. Recently, biportal endoscopic surgery has been widely performed with developed surgical techniques to treat cervical radiculopathy as well as central canal stenosis [ 12 - 14 ].…”

Unilateral Biportal Endoscopy for Decompression of Extraforaminal Stenosis at the Lumbosacral Junction: Surgical Techniques and Clinical Outcomes

“…10,11 Lately, due to advancements in endoscopic spine surgery, the unilateral biportal endoscopic (UBE) technique has been applied in the cervical, thoracic and lumbar spine. [12][13][14][15] For extraforaminal stenosis at L5-S1, the UBE technique, which can go further into the extraforaminal lesion less invasively, is becoming widespread and surpassing microscopic surgery in popularity. The purpose of this study is to present the UBE technique for complete decompression of extraforaminal stenosis at L5-S1 and evaluate 1-year clinical outcomes.…”