Comparative study of biportal endoscopic and microscopic posterior cervical foraminotomy: clinical and radiological outcomes with minimum 2-year follow-up.

Objective

Biportal endoscopic posterior cervical foraminotomy (BE-PCF) has gained popularity as a minimally invasive technique for the treatment of unilateral cervical radiculopathy. Although BE-PCF is expected to reduce tissue injury while providing effective neural decompression, long-term comparative data with minimally invasive microscopic PCF are limited. The aim of this study was to compare clinical outcomes, perioperative parameters, and tissue injury profiles between patients who underwent BE-PCF and those who underwent microscopic PCF with a minimum 2-year follow-up.

Methods

This retrospective comparative study included 126 patients who underwent single-level PCF (69 with BE-PCF and 57 with microscopic PCF). Clinical outcomes were assessed using visual analog scale (VAS) scores for neck and arm pain and the Neck Disability Index (NDI). Perioperative variables, complications, and reoperation rates were analyzed. Muscle and soft tissue injury were evaluated using serum biomarkers, including creatine phosphokinase (CPK) and C-reactive protein (CRP) levels, and MRI-based muscle injury scoring. Radiological assessment included postoperative MRI and dynamic radiography for instability.

Results

Both procedure groups showed significant improvement in VAS and NDI scores at the final follow-up. The BE-PCF group demonstrated significantly lower neck pain at postoperative day 1 and at the final follow-up. There were no significant differences in arm pain or functional outcomes between groups. Estimated blood loss was significantly lower in the BE-PCF group. Postoperative increases in CPK and CRP levels were significantly higher in the microscopic PCF group, indicating greater muscle and soft tissue injury. MRI-based muscle injury scores were also significantly lower in the BE-PCF group. Complication and reoperation rates were comparable between the two groups, and no postoperative instability was observed.

Conclusions

BE-PCF provides clinical outcomes comparable with that of microscopic PCF while significantly reducing muscle and soft tissue injury. These findings suggest that BE-PCF is a safe and effective minimally invasive alternative for the treatment of unilateral cervical radiculopathy.