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

Abstract

Objective:The aim of this study was to compare the clinical and radiologic outcomes of three types of minimally invasive posterior cervical foraminotomy (PCF): uniportal endoscopic surgery, biportal endoscopic surgery, and microsurgery.Methods: Between January 2019 to January 2020, PCF was performed using three different approaches to treat foraminal stenosis. The foraminal expansion rate, facet resection rate, and surgical foraminal approach angle were measured using magnetic resonance imaging. Visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), MacNab criteria, operation time, hospital stay, and complications were assessed.Clinical and radiologic parameters were compared among the three surgical groups.Results: There were 38, 30, and 50 patients in the uniportal endoscopy, biportal endoscopy, and microscopy groups, respectively. Microscopy group displayed significantly higher foraminal expansion compared to uniportal endoscopy group (p=0.001). Facet resection rates and inclination angle for facet joint undercutting were significantly different among the three groups. Uniportal endoscopy group had the highest inclination angle and the least facet resection. On the 6-month and final follow-up, VAS scores and NDI were significantly lower in the uniportal endoscopy group than in the microscopy group (p=0.000). Conclusions:All three types of PCF displayed favorable clinical outcomes and sufficient expansion of the midforaminal area. Two endoscopy groups showed a significantly higher inclination angle for undercutting the facet joint and a lower facet resection rate than the microscopy group. Reduced facet joint resection using an inclinatory approach did not interfere with sufficient foraminal expansion and enhanced the clinical result after 6 months of follow-up.

Comparative Analysis With Modified Inclined Technique for Posterior Endoscopic Cervical Foraminotomy in Treating Cervical Osseous Foraminal Stenosis: Radiological and Midterm Clinical Outcomes

“…[7][8][9][10] Endoscopic systems offer a multiaxial viewing angle and a magnified clear endoscopic view that enable detailed bone decompression using various approaches. 9,11 A recent comparative study by Kim et al 12 revealed that endoscopic PCF offered enhanced facet joint preservation and improved midterm clinical results compared to microscopic PCF. Furthermore, full endoscopy offers a safe surgical route for ventral foraminal decompression via partial pediculotomy or partial vertebrotomy, and it shows good surgical outcomes.…”

“…We measured 4 parameters to document the changes in the neural foraminal space and facet on the pre-and postoperative T2-weighted MRI using the methods described by Nakamura and Taguchi 17 and Kim et al 12 Two values for the middle and distal foraminal widths and one for the facet length were measured on axial MRI from the intervertebral disc levels. One foraminal height value was measured on oblique sagittal MRI from the middle pedicle level.…”

Endoscopic Posterior Cervical Foraminotomy

“…Minimally invasive tubular techniques have demonstrated clinical effectiveness on par with open PCF but with less blood loss, analgesic use, immediate postoperative neck pain, and hospital length of stay 19,20. Endoscopy allows surgeons to accomplish PCF in an even less traumatic fashion—resulting in less postoperative neck pain and shorter hospital stays than other techniques—without sacrificing clinical effectiveness 11,12…”

“…19,20 Endoscopy allows surgeons to accomplish PCF in an even less traumatic fashion-resulting in less postoperative neck pain and shorter hospital stays than other techniques-without sacrificing clinical effectiveness. 11,12 The benefits of endoscopic techniques extend beyond preservation of the paraspinal soft tissues. The angled optics of the endoscope allow for viewing deeper within the foramen, and the narrow endoscopic working cannula can be oriented in a more medial-to-lateral trajectory before abutting the spinous process than can a conventional tubular retractor-these features both permit more extensive SAP undercutting.…”

“…Surgeons first incorporating endoscopic techniques into their practices are encouraged to begin with pathology in the more forgiving environment of the lumbar spine 10. However, more advanced applications such as PCF are safe and reliable in the hands of an experienced endoscopic spine surgeon 11,12. This article reviews the indications, surgical technique, and scientific literature pertaining to endoscopic PCF.…”