Contralateral Inside-out Biportal Endoscopic Posterior Cervical Foraminotomy: Surgical Techniques and Preliminary Clinical Outcomes

Abstract

Objective: The aim of this study was to describe the surgical techniques and preliminary results of inside-out biportal endoscopic posterior cervical foraminotomy (BEPCF) for unilateral cervical radiculopathy.Methods: This study involved 36 consecutive patients (38 segments) who underwent BEPCF for unilateral cervical radiculopathy between November 2020 and June 2022. Foraminotomy was performed using the biportal endoscopic technique, with the surgeon standing on the opposite side and making skin incisions on the same side of the foramen stenosis. After widening of the V-point and exposing the nerve root using a high-speed drill, we used a curved osteotome to undercut the facet joint from inside the foramen to complete the nerve root decompression. Results: The study followed patients for an average of 15.5 months and found significant improvements in the visual analog scale for arm pain, from 7.3 ± 2.2 to 0.9 ± 0.7 (P < 0.005), and the Neck Disability Index, from 54.6 ± 16.9 to 14.6 ± 12.6 (P < 0.005). Almost all patients (94.4%) had good or excellent results. Hospitalization lasted an average of 3.2 days and postoperative magnetic resonance imaging showed successful neural decompression. Complications were minimal, with only two cases of asymptomatic root abrasions and one case of transient neuralgia. One patient required re-operation due to incomplete decompression.Conclusion: BEPCF is a safe and effective surgical technique for treating cervical radiculopathy. The surgeon can achieve good neural decompression and preserve the facet joint using the inside-out approach in an ergonomic setting.