Early experience of single level full endoscopic posterior cervical foraminotomy and comparison with microscope-assisted open surgery.

BACKGROUND: Posterior cervical foraminotomy (PCF) is one of the standard surgeries for treatment of cervical spondylotic radiculopathy. Full endoscopic application for PCF has recently applied to minimize traumatization of the surgical access. Here we present our early experience of full endoscopic PCF (FEPCF) and compared with results of microscope-assisted open PCF (OPCF) surgery.

METHODS: Seven cases of one level FEPCF were carried out during March and November of 2019, and seven cases of previously performed one level OPCF were included for comparison in this study. Operating time, foraminotomy area calculating from postoperative reconstructed 3D-computed tomography (3D-CT) scan, improvement of Oswestry neck disability index (ONDI) at 1 month after surgery, and use of postoperative PRN medication were compared. Mann-Whitney's U-test was used for statistical analysis.

RESULTS: Operating time of FEPCF and OPCF was 70.9 and 85.0 min respectively and not statistically different (P=0.37). Foraminotomy area of FEPCF was 51.67 cm2, significantly smaller than that of OPCF of 93.47 cm2 (P=0.025). Improvement of ONDI 1 month after surgery was not significantly different (50.4% for FEPCF and 41.0% for OPCF, P=0.72). Use of postoperative PRN pain medication was significantly less in FEPCF, 0.57 times as compared with OPCF, 8.71 times (P=0.0022).

CONCLUSIONS: One level FEPCF is as effective as OPCF in alleviation of radiculopathy related symptoms and requires similar operating time as OPCF. In addition, FEPCF significantly reduces foraminotomy area requires for nerve root decompression, and use of postoperative pain medication compared with OPCF. FEPCF is technically feasible and considered as less invasive treatment options for cervical spondylotic radiculopathy as compared with OPCF.