Purpose: Posterior endoscopic surgery has become a mainstream minimally invasive approach for the treatment of cervical spondylotic radiculopathy (CSR). Arthroscopic-assisted uni-portal spine surgery (AUSS), an emerging technique, has demonstrated favorable clinical outcomes in lumbar spine surgery; however, its feasibility and effectiveness in cervical spine surgery have not yet been reported. Accordingly, this technical note aimed to describe the surgical technique of AUSS combined with Kirschner wire anchoring for the treatment of CSR and to evaluate its preliminary clinical outcomes.
Methods: Fifteen consecutive CSR patients (9 males, 6 females) underwent AUSS combined with Kirschner wire anchoring between February and October 2024. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for neck and arm pain, the Neck Disability Index (NDI), and the modified MacNab criteria. Pre- and postoperative pain and functional scores were compared using a paired t-test, with effect sizes (Cohen's d) and 95% confidence intervals (CIs) for mean differences calculated. Radiological parameters included osteotomy area and facet joint resection rate.
Results: All procedures were successfully completed with a mean operative time of 97.7 ± 18.2 min and a mean incision length of 1.7 ± 0.2 cm. Postoperatively, VAS score for arm improved from 6.5 ± 0.9 to 2.8 ± 0.7 (p < 0.05), VAS score for neck from 4.3 ± 1.9 to 2.7 ± 1.0 (p < 0.05), and NDI from 54.3 ± 6.7 to 9.7 ± 2.4 (p < 0.05). The mean osteotomy area measured 98.6 ± 12.1 mm2, with a facet joint removal rate of 27.6% ± 8.6%. At the 6-month follow-up, 86.7% (13/15) of patients achieved excellent/good outcomes. No serious surgery-related complications were observed.
Conclusion: The AUSS with Kirschner wire anchoring achieved significant pain relief and functional improvement in CSR, demonstrating feasibility and safety in the short term. However, larger cohorts and long-term studies are required to validate its efficacy.
| [1] |
C. Liu, K. Liu, L. Chu, L. Chen, and Z. Deng, “Posterior Percutaneous Endoscopic Cervical Discectomy Through Lamina-Hole Approach for Cervical Intervertebral Disc Herniation,” International Journal of Neuroscience 129, no. 7 (2019): 627–634, https://doi.org/10.1080/00207454.2018.1503176.
|
| [2] |
C. Liao, Q. Ren, L. Chu, et al., “Modified Posterior Percutaneous Endoscopic Cervical Discectomy for Lateral Cervical Disc Herniation: The Vertical Anchoring Technique,” European Spine Journal 27, no. 6 (2018): 1460–1468, https://doi.org/10.1007/s00586-018-5527-y.
|
| [3] |
H. S. Kim, P. H. Wu, E. Tze-Chun Lau, and I. T. Jang, “Narrative Review of Uniportal Posterior Endoscopic Cervical Foraminotomy,” World Neurosurgery 181 (2024): 148–153, https://doi.org/10.1016/j.wneu.2023.10.021.
|
| [4] |
H. Ji-Jun, S. Hui-Hui, S. Zeng-Wu, Z. Liang, L. Qing, and Z. Heng-Zhu, “Posterior Full-Endoscopic Cervical Discectomy in Cervical Radiculopathy: A Prospective Cohort Study,” Clinical Neurology and Neurosurgery 195 (2020): 105948, https://doi.org/10.1016/j.clineuro.2020.105948.
|
| [5] |
Z. Zhong, Q. Hu, L. Huang, S. Zhang, and M. Zhou, “Unilateral Biportal Endoscopic Posterior Cervical Foraminotomy: An Outcome Comparison With the Full-Endoscopic Posterior Cervical Foraminotomy,” Clinical Spine Surgery 37, no. 1 (2024): 23–30, https://doi.org/10.1097/BSD.0000000000001507.
|
| [6] |
A. Platt, C. S. Gerard, and J. E. O'Toole, “Comparison of Outcomes Following Minimally Invasive and Open Posterior Cervical Foraminotomy: Description of Minimally Invasive Technique and Review of Literature,” Clinical Spine Surgery 6, no. 1 (2020): 243–251, https://doi.org/10.21037/jss.2020.01.08.
|
| [7] |
Y. Ahn, “The Current State of Cervical Endoscopic Spine Surgery: An Updated Literature Review and Technical Considerations,” Expert Review of Medical Devices 17, no. 12 (2020): 1285–1292, https://doi.org/10.1080/17434440.2020.1853523.
|
| [8] |
Y. Zhang, J. Dai, G. Dai, W. Zhan, Y. Wang, and P. Hu, “Comparison of Clinical Efficacy of Posterior Percutaneous Endoscopic Cervical Discectomy Versus Unilateral Biportal Endoscopy Key-Hole Techniques for Cervical Spondylotic Radiculopathy: A Retrospective Study With 2 Years,” Journal of Orthopaedic Surgery and Research 20, no. 1 (2025): 200, https://doi.org/10.1186/s13018-025-05617-2.
|
| [9] |
W. Peng, R. Chu, W. Cui, et al., “Unilateral Biportal Endoscopic Decompression Versus Anterior Cervical Decompression and Fusion for Unilateral Cervical Radiculopathy or Coexisting Cervical Myelopathy: A Prospective, Randomized, Controlled, Noninferiority Trial,” BMC Musculoskeletal Disorders 25, no. 1 (2024): 582, https://doi.org/10.1186/s12891-024-07697-3.
|
| [10] |
Z. Tang, L. Jian, Y. Liu, et al., “Comparative Efficacy of Unilateral Biportal Endoscopic and Full-Endoscopic Posterior Cervical Foraminotomy in the Treatment of Cervical Spondylotic Radiculopathy: A Retrospective Analysis,” Neurosurgical Review 47, no. 1 (2024): 803, https://doi.org/10.1007/s10143-024-03046-z.
|
| [11] |
F. Wang, R. Wang, C. Zhang, E. Song, and F. Li, “Clinical Effects of Arthroscopic-Assisted Uni-Portal Spinal Surgery and Unilateral Bi-Portal Endoscopy on Unilateral Laminotomy for Bilateral Decompression in Patients With Lumbar Spinal Stenosis: A Retrospective Cohort Study,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 167, https://doi.org/10.1186/s13018-024-04621-2.
|
| [12] |
S. Zhou, X. Xu, T. Guo, J. Sun, and A. Jiancuo, “Comparison of Short-Term Clinical Outcomes and Muscle Injury in Patients With Lumbar Spinal Stenosis Undergoing Arthroscopic-Assisted Uni-Portal Spinal Surgery, Unilateral Biportal Endoscopic Surgery, and Percutaneous Interlaminar Lumbar Discectomy: A Six-Month Follow-Up,” Journal of Orthopaedic Surgery and Research 20, no. 1 (2025): 684, https://doi.org/10.1186/s13018-025-06088-1.
|
| [13] |
Y. Li, F. Qian, F. Sun, and E. Song, “Arthroscopic-Assisted Uni-Portal Spinal Surgery Combined With Modified Unilateral Laminotomy With Bilateral Decompression for the Treatment of Lumber Epidural Lipomatosis: Case Report and New Therapeutic Method,” Journal of Orthopaedics 58 (2024): 90–95, https://doi.org/10.1016/j.jor.2024.07.003.
|
| [14] |
J. Li, Z. Ge, D. Zhang, et al., “Comparison of the Efficacy of Arthroscopic-Assisted Uni-Portal Spinal Surgery and Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Far Lateral Lumbar Disc Herniation: A Retrospective Controlled Study,” European Spine Journal 34, no. 10 (2025): 4415–4427, https://doi.org/10.1007/s00586-025-08998-4.
|
| [15] |
S. Wu, D. Zhong, G. Zhao, Y. Liu, and Y. Wang, “Comparison of Clinical Outcomes Between Unilateral Biportal Endoscopic Discectomy and Percutaneous Endoscopic Interlaminar Discectomy for Migrated Lumbar Disc Herniation at Lower Lumbar Spine: A Retrospective Controlled Study,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 21, https://doi.org/10.1186/s13018-023-04484-z.
|
| [16] |
D. H. Heo, D. C. Lee, and C. K. Park, “Comparative Analysis of Three Types of Minimally Invasive Decompressive Surgery for Lumbar Central Stenosis: Biportal Endoscopy, Uniportal Endoscopy, and Microsurgery,” Neurosurgical Focus 46, no. 5 (2019): E9, https://doi.org/10.3171/2019.2.FOCUS197.
|
| [17] |
C. Zhu, W. Cheng, D. Wang, H. Pan, and W. Zhang, “A Helpful Third Portal for Unilateral Biportal Endoscopic Decompression in Patients With Cervical Spondylotic Myelopathy: A Technical Note,” World Neurosurgery 161 (2022): 75–81, https://doi.org/10.1016/j.wneu.2022.02.021.
|
| [18] |
K. S. Song and C. W. Lee, “The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results,” Neurospine 17, no. Suppl 1 (2020): S145–S153, https://doi.org/10.14245/ns.2040228.114.
|
| [19] |
Y. Feng, W. Zhang, K. Li, et al., “Evaluation of the Effectiveness of Cervical One-Hole Split Endoscopic Keyhole Surgery for Cervical Radiculopathy,” Journal of Pain Research 17 (2024): 3093–3099, https://doi.org/10.2147/JPR.S451943.
|
| [20] |
H. S. Kim, P. H. Wu, B. Z. J. Chin, and I. T. Jang, “Clinical and Radiological Outcomes of a Comparative Study of Anterior Cervical Decompression and Fusion With Partial Pediculotomy, Partial Vertebrotomy (PPPV) Posterior Endoscopic Cervical Decompression (PECD) for Cervical Foraminal Pathology,” Medicina (Kaunas, Lithuania) 59, no. 7 (2023): 1222.
|
| [21] |
T. A. Zdeblick, D. Zou, K. E. Warden, R. McCabe, D. Kunz, and R. Vanderby, “Cervical Stability After Foraminotomy. A Biomechanical In Vitro Analysis,” Journal of Bone and Joint Surgery. American Volume 74, no. 1 (1992): 22–27.
|
| [22] |
R. B. Raynor, J. Pugh, and I. Shapiro, “Cervical Facetectomy and Its Effect on Spine Strength,” Journal of Neurosurgery 63, no. 2 (1985): 278–282, https://doi.org/10.3171/jns.1985.63.2.0278.
|
| [23] |
G. Keorochana, C. Tantrakansakun, C. Suriyonplengsaeng, et al., “The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study,” Global Spine Journal 14, no. 7 (2024): 2116–2123, https://doi.org/10.1177/21925682231217251.
|
| [24] |
C. H. Kim, K. T. Kim, C. K. Chung, et al., “Minimally Invasive Cervical Foraminotomy and Diskectomy for Laterally Located Soft Disk Herniation,” European Spine Journal 24, no. 12 (2015): 3005–3012, https://doi.org/10.1007/s00586-015-4198-1.
|
| [25] |
Z. Li, W. Zhou, J. Liang, et al., “Clinical Efficacy and Complications of Spinal Surgery Unilateral Biportal Endoscopy for Cervical Spondylosis: A Systematic Review and Meta-Analysis,” World Neurosurgery 194 (2025): 123386, https://doi.org/10.1016/j.wneu.2024.10.115.
|
| [26] |
H. J. Park, S. K. Kim, S. C. Lee, W. Kim, S. Han, and S. S. Kang, “Dural Tears in Percutaneous Biportal Endoscopic Spine Surgery: Anatomical Location and Management,” World Neurosurgery 136 (2020): e578–e585, https://doi.org/10.1016/j.wneu.2020.01.080.
|
| [27] |
H. Wang, Y. Wang, Z. Jiang, and W. Zhang, “Case Report: Bacterial Meningitis due to Cerebrospinal Fluid Leakage Following Unilateral Biportal Endoscopic Spinal Surgery: A Cautionary Tale,” Frontiers in Surgery 11 (2024): 1301905, https://doi.org/10.3389/fsurg.2024.1301905.
|
| [28] |
D. Jia, X. Qiao, X. Wang, et al., “Early Efficacy Observation of the Unilateral Biportal Endoscopic Technique in the Treatment of Multi-Level Lumbar Spinal Stenosis,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 117, https://doi.org/10.1186/s13018-024-04575-5.
|
| [29] |
D. Wang, J. Xu, C. Zhu, W. Zhang, and H. Pan, “Comparison of Outcomes Between Unilateral Biportal Endoscopic and Percutaneous Posterior Endoscopic Cervical Keyhole Surgeries,” Medicina (Kaunas, Lithuania) 59, no. 3 (2023): 437, https://doi.org/10.3390/medicina59030437.
|
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