Initial follow-up results in patients undergoing uniportal full endoscopic cervical unilateral laminotomy for bilateral decompression

OBJECTIVE: Cervical spondylosis affects 5%-20% of the population and is commonly managed with posterior decompression. However, early studies of laminectomy without fusion revealed a significant risk of postoperative kyphosis, leading to the adoption of laminectomy with posterior fixation or laminoplasty as the standard of care. The aim of this study was to assess whether posterior decompression performed via a uniportal full endoscopic approach can achieve adequate decompression of the cervical spinal cord while preserving postoperative alignment. METHODS: This single-surgeon single-institution retrospective case series included patients who underwent uniportal full endoscopic cervical unilateral laminotomy for bilateral decompression (UNI-CE-ULBD) between August 2023 and August 2024. Radiography, CT, and MRI performed preoperatively and at 1, 3, 6, and 12 months postoperatively were used to assess canal decompression, cervical alignment, and range of motion (ROM). RESULTS: UNI-CE-ULBD was performed in 42 patients, and 15 patients (10 male, mean age 61.1 ± 9.9 years) who completed ≥ 9 months of follow-up (mean 12.1 ± 3.8 months, range 9.0-18.1) were included in the analysis. The mean canal stenosis improved from 37.2% ± 12.1% preoperatively to 5.2% ± 14.5% 6 months postoperatively (p < 0.0001). No significant change in cervical alignment, segmental angles, or ROM was observed. Four patients exhibited mild reductions in cervical lordosis. Clinically, patients showed significant improvements in neck/arm pain and myelopathy. Of 6 patients with preoperative motor deficits, 4 improved measurably and none experienced new or worsening deficits. The mean modified Japanese Orthopaedic Association score increased from 14.0 ± 1.7 to 15.7 ± 1.0 (p = 0.0001). There were no intraoperative complications, perioperative adverse events, or reoperations. CONCLUSIONS: In this retrospective case series, UNI-CE-ULBD achieved effective cervical cord decompression without short-term postoperative malalignment and might offer a minimally invasive alternative to traditional fusion-based posterior approaches in appropriately selected patients.