Endoscopic Posterior Cervical Craniolateral Inclinatory Foraminotomy: A Novel Approach for Lamina Preservation During Tandem Decompression of Cervical Spondylotic Radiculopathy Via Unilateral Biportal Endoscopic Spinal Surgery

Study design: Case series.

Objective: Endoscopic posterior cervical foraminotomy gains attention for cervical radiculopathy due to its feasibility, better outcomes, and lower complications than traditional approaches, enabling efficient multilevel decompression in a single operation while avoiding anterior cervical diskectomy and fusion-related issues. However, with multilevel decompression, the remnant lamina becomes thin and fragile. We propose craniolateral inclinatory foraminotomy to minimize bone removal during laminotomy, reducing the risk of iatrogenic or postoperative lamina fractures in tandem decompression.

Materials and methods: From 2021 to 2022, 8 consecutive patients underwent the procedure and were followed up for at least 6 months. The VAS, NDI, and MacNab scores were recorded for clinical recovery and patient satisfaction evaluations. Preoperative and postoperative CT scans were utilized to measure the lamina preservation percentage at each level.

Results: The clinical outcomes improved significantly in every patient. No postoperative neck pain, segmental instability, or lamina fracture were observed. The mean lamina preservation percentages of C5, C6, C7, and all vertebrae were 68.8%, 73.22%, 71.86%, and 72.18%, respectively.

Conclusions: Ongoing technical adjustments will accompany endoscopic technique development to decrease complications and enhance benefits. Our reported technique avoids extensive laminotomy in multilevel tandem decompression, aiming to prevent lamina fractures and anticipate a reduction in postoperative neck pain.

Level of evidence: Level IV.