Biportal Endoscopic Posterior Cervical Revision Surgery for Recurrent Cervical Degenerative Pathology: A Technical Report

Objective: Revision surgery for recurrent cervical radiculopathy or myelopathy after posterior decompression is technically challenging because of epidural adhesions, altered anatomy, and the risk of postoperative instability. Although anterior cervical discectomy and fusion is commonly performed, it sacrifices segmental motion and is associated with fusion-related morbidity. This technical report describes the surgical technique and early clinical outcomes of unilateral biportal endoscopic (UBE) posterior cervical revision as a motion-preserving alternative.Methods: Five patients underwent UBE-assisted posterior cervical revision surgery for recurrent cervical disc herniation, foraminal stenosis, or central canal stenosis. Procedures included inclinatory foraminotomy or unilateral laminotomy with bilateral decompression, depending on pathology. Clinical outcomes were evaluated using visual analogue scale (VAS) scores for neck and arm pain, motor strength assessment, radiographic evaluation, and modified MacNab criteria. All patients were followed for at least 1 year.Results: All procedures were completed without conversion to open surgery or the need for fusion. Adequate neural decompression was achieved in all cases, with preservation of facet joint integrity and cervical alignment. Neck pain VAS scores improved from 4–8 preoperatively to 0–1 at 1 year postoperatively, while arm pain VAS scores improved from 7–9 to 0–2. Motor weakness improved in all patients who presented with preoperative deficits. No intraoperative or postoperative complications were observed during the follow-up period.Conclusion: UBE-assisted posterior cervical revision surgery appears to be a feasible and effective minimally invasive option for selected patients. This technique allows sufficient decompression while preserving cervical motion and avoiding fusion-related morbidity.