1.Algorithmic Approach to Combined Standard and Inclinatory Foraminotomy via Unilateral Biportal Endoscopy for Cervical Foraminal Stenosis Using Sagittal-Oblique Computed Tomography
Malcolm Darayes PESTONJI ; Sharvari Rajendra GUNJOTIKAR ; Sucheta TIRPUDE ; Kai-Uwe LEWANDROWSKI
Journal of Minimally Invasive Spine Surgery and Technique 2026;11(Suppl 1):S177-S186
Objective:
Cervical foraminotomy is a critical surgical intervention for addressing foraminal stenosis. Traditional magnetic resonance imaging may be insufficient for diagnosing transcanal stenosis. This lacuna is efficiently solved by using 2-dimensional sagittal-oblique multiplanar reconstruction computed tomography (CT) scans (2D-SOMPR). Standard medial facetectomy is insufficient if pathology extends to the outer foramen. This study investigates a combined approach, utilizing unilateral biportal endoscopy with CT scan-aided imaging, to achieve decompression in complex foraminal stenosis.
Methods:
A cohort of 23 patients with severe transcanal foraminal stenosis underwent the combined foraminotomy technique. Thirteen patients received single-level decompression, while 4 underwent multilevel procedures. Three patients with bilateral root involvement underwent hemilaminectomy for cervical myelopathy.
Results:
All patients reported complete neurological symptom relief at a mean follow-up of 12 months. Visual analogue scale and Neck Disability Index scores showed significant improvements, with 22 patients achieving excellent outcomes. Minor transient irritation of the exiting nerve root was observed in 8 patients, resolving within 8 weeks. One patient with preoperative C5–6–7 root palsy experienced partial recovery. No permanent neurological deficits, infections, or surgical complications were noted.
Conclusion
The combined standard and inclinatory foraminotomy approach is a safe and effective solution for complex cervical foraminal stenosis. This technique ensures complete neural decompression while preserving facet joint function.
2.Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Vit KOTHEERANURAK ; Khanathip JITPAKDEE ; Kai-Uwe LEWANDROWSKI ; Guang-Xun LIN ; Weerasak SINGHATANADGIGE ; Worawat LIMTHONGKUL ; Wicharn YINGSAKMONGKOL ; Jin-Sung KIM ; Wongthawat LIAWRUNGRUEANG
Neurospine 2024;21(3):1040-1050
Objective:
To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy.
Methods:
Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared.
Results:
Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05).
Conclusion
PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.
3.Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Vit KOTHEERANURAK ; Khanathip JITPAKDEE ; Kai-Uwe LEWANDROWSKI ; Guang-Xun LIN ; Weerasak SINGHATANADGIGE ; Worawat LIMTHONGKUL ; Wicharn YINGSAKMONGKOL ; Jin-Sung KIM ; Wongthawat LIAWRUNGRUEANG
Neurospine 2024;21(3):1040-1050
Objective:
To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy.
Methods:
Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared.
Results:
Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05).
Conclusion
PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.
4.Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Vit KOTHEERANURAK ; Khanathip JITPAKDEE ; Kai-Uwe LEWANDROWSKI ; Guang-Xun LIN ; Weerasak SINGHATANADGIGE ; Worawat LIMTHONGKUL ; Wicharn YINGSAKMONGKOL ; Jin-Sung KIM ; Wongthawat LIAWRUNGRUEANG
Neurospine 2024;21(3):1040-1050
Objective:
To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy.
Methods:
Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared.
Results:
Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05).
Conclusion
PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.
5.Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Vit KOTHEERANURAK ; Khanathip JITPAKDEE ; Kai-Uwe LEWANDROWSKI ; Guang-Xun LIN ; Weerasak SINGHATANADGIGE ; Worawat LIMTHONGKUL ; Wicharn YINGSAKMONGKOL ; Jin-Sung KIM ; Wongthawat LIAWRUNGRUEANG
Neurospine 2024;21(3):1040-1050
Objective:
To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy.
Methods:
Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared.
Results:
Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05).
Conclusion
PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.
6.Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Vit KOTHEERANURAK ; Khanathip JITPAKDEE ; Kai-Uwe LEWANDROWSKI ; Guang-Xun LIN ; Weerasak SINGHATANADGIGE ; Worawat LIMTHONGKUL ; Wicharn YINGSAKMONGKOL ; Jin-Sung KIM ; Wongthawat LIAWRUNGRUEANG
Neurospine 2024;21(3):1040-1050
Objective:
To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy.
Methods:
Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared.
Results:
Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05).
Conclusion
PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.

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