Assessment of Clinical and Radiologic Outcomes of Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy : A Retrospective Cohort Study.

Abstract

Objective: To evaluate clinical and radiological outcomes of biportal endoscopic posterior cervical inclinatory foraminotomy (BE-PCIF) to treat cervical spondylotic radiculopathy (CSR).

Methods: This retrospective study included patients with CSR who underwent BE-PCIF between April 2020 and April 2023. Patient demographic data were collected and clinical outcomes were assessed using the visual analog scale (VAS) and MacNab criteria. Various radiological parameters, including inclinatory angles, were collected and correlations with demographic or radiological factors were evaluated.

Results: We included 101 patients (46 men and 55 women) with a mean age of 56.99 years, encompassing 162 surgical levels primarily affecting the C5-6 and C6-7 vertebrae. The postoperative VAS scores decreased to <1, with 90.1% of patients reporting excellence according to the MacNab criteria. None of the patients experienced any major postoperative complications, including instability. The isthmic distance (ID) expansion ratio, representing the degree of distal decompression, was 2.4, with a minor facet resection rate of 0.4. Right-sided surgeries or surgeries at lower cervical levels correlated with higher inclinatory angles, with a p-value of 0.003 each. Significant correlations were noted between the inclinatory angle and both the facet resection rate and ID expansion ratio, with coefficients of 0.45 and 0.3, respectively, both having a p-value of <0.001, indicating strong statistical significance.

Conclusion: BE-PCIF effectively relieves pain and enhances clinical outcomes in CSR patients. The use of the inclinatory angle approach facilitates cervical foraminal expansion and sufficient neural decompression, with higher angles required for adequate decompression at lower cervical levels.