Clinical and radiological outcomes of biportal endoscopic posterior cervical foraminotomy: a single-center retrospective cohort study with 1-year follow-up.

Abstract

Study design: Retrospective single-center cohort study.

Purpose: To evaluate 1-year clinical and radiological outcomes of biportal endoscopic posterior cervical foraminotomy (BE-PCF) in cervical spondylotic radiculopathy (CSR).

Overview of literature: CSR is commonly managed with anterior cervical discectomy and fusion, cervical disc replacement, or posterior cervical foraminotomy. However, these approaches may lead to fusion-related complications, prosthesis degeneration, or posterior tension band disruption. Minimally invasive techniques, such as biportal endoscopic spine surgery, aim to reduce tissue damage while maintaining effective decompression. Long-term outcome data for BE-PCF remain limited.

Methods: Twenty-one patients (31 levels) who underwent BE-PCF (June 2023-December 2024) were retrospectively analyzed. Clinical outcomes included Visual Analog Scale (VAS) scores for neck and arm pain and Neck Disability Index (NDI) at baseline, discharge, 6 months, and 1 year. Radiological outcomes were assessed using dynamic radiographs (C2C7 and segmental range of motion [ROM]) and computed tomography (CT) at 6 months, evaluating facet resection, foraminal diameter, and approach angle.

Results: Mean follow-up was 14.8±6.7 months. VAS and NDI improved significantly (p<0.001). Neck pain decreased from 6.9±1.1 to 2.5±0.7, arm pain from 8.1±0.7 to 2.0±0.6, and NDI from 30.8±3.6 to 12.2±1.6. Cervical ROM was preserved (C2C7: 40.5°±10.1° vs. 40.5°±10.3°, p=0.99; segmental: 13.1°±4.4° vs. 13.8°±5.7°, p=0.18). CT demonstrated significant foraminal enlargement (mid-foraminal: 4.2±0.8 to 6.5±1.0 mm; distal: 3.7±1.1 to 4.8±1.0 mm; both p<0.001). Mean facet resection was 34.6%±7.7%, with no case exceeding 50%. Complications included transient C5 palsy (4.7%) and one wrong-level surgery (3.2%).

Conclusions: BE-PCF is a safe and effective minimally invasive option for CSR, providing significant clinical improvement, preserved cervical motion, and adequate decompression with low complication rates at 1 year.