Algorithmic Approach to Combined Standard and Inclinatory Foraminotomy via Unilateral Biportal Endoscopy for Cervical Foraminal Stenosis Using Sagittal-Oblique Computed Tomography

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.