Comparative efficacy and safety of unilateral biportal endoscopic posterior cervical foraminotomy versus anterior cervical discectomy and fusion for single-level cervical radiculopathy: a retrospective cohort study.

BACKGROUND

Anterior cervical discectomy and fusion (ACDF) is widely used for cervical radiculopathy but may limit segmental motion. Unilateral biportal endoscopy (UBE) has emerged as a minimally invasive alternative; however, comparative evidence remains limited. This study aims to compare the clinical efficacy and safety of UBE and ACDF in patients with single-level cervical radiculopathy, with a particular focus on early recovery and motion preservation.

METHODS

This single-center retrospective study included patients with single-level cervical radiculopathy treated with UBE or ACDF between February 2020 and November 2024. Patients with multilevel disease, prior cervical surgery, or incomplete follow-up were excluded. Propensity score matching (1:1) was performed to reduce selection bias, yielding 38 patients in each group. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and cervical range of motion (ROM) at postoperative 5 days, 3 months, and 12 months. Perioperative parameters were also analyzed.

RESULTS

Baseline characteristics were well-balanced after matching. Both groups exhibited significant postoperative improvement. The UBE group showed significantly lower VAS and NDI scores in the early postoperative period (5 days: VAS 2.39±0.86 vs. 2.87±1.09, P=0.03; NDI 13.95±2.77 vs. 16.24±2.26, P<0.001), whereas no significant differences were observed at 12 months. Cervical ROM was significantly better preserved in the UBE group at both 3 and 12 months (P<0.001). Although operative time was longer in the UBE group (P<0.001), it was associated with shorter hospital stay (P=0.002) and faster return to work (P<0.001).

CONCLUSIONS

UBE and ACDF achieved comparable pain relief and functional recovery. UBE may offer advantages in motion preservation and earlier return to work. However, due to the retrospective design, these findings require confirmation in prospective randomized studies.