Unilateral Biportal Endoscopic Cervical Foraminotomy

Study Design: Retrospective cohort study. Objective: This study presents an initial case series evaluating the safety, feasibility, and early recovery outcomes of biportal endoscopic posterior cervical foraminotomy (UBE-PCF) for single-level decompression. Summary of Background Data: While endoscopic approaches have gained traction in the lumbar spine, their application in the cervical spine remains limited. Biportal endoscopic cervical decompression may improve visualization and maneuverability while minimizing tissue disruption. Methods: A retrospective review was performed of the first 17 patients who underwent one-level UBE-PCF at a single academic institution (CPT 63045 or 63020, 2023–2025). Data included demographics, comorbidities, operative details, discharge disposition, and patient-reported outcome measures (PROMs: EQ. 5D, VAS, PROMIS Physical Function, PROMIS Pain Interference, PROMIS Depression). PROMs were compared pre-postoperatively and postoperatively using paired t tests and Wilcoxon signed-rank tests. Results: The cohort had a mean age of 50.3 years and a mean BMI of 28.5 (64.7% female). Most patients had a mild comorbidity burden (Charlson Comorbidity Index 0–2 in 76.5%; ASA II in 64.7%). Median operative time was 74 minutes (IQR: 66–83), and median length of stay was 0.46 days (IQR: 0.38–1.29), with most patients discharged the same day. Mean follow-up was 0.57 years. Postoperative PROMs showed improvement across all domains. PROMIS Pain Interference significantly decreased (pre-op 69.6±8.9 vs. post-op 60.2±9.3, P =0.041). Improvements were observed in PROMIS Physical Function (+4.1), EQ. 5D (+7.5), NDI (−13.4) and VAS pain (−0.55), though not statistically significant. PROMIS Depression trended downward (pre-op median 56.0 vs. post-op 52.0, P =0.17). Conclusion: This retrospective case series provides preliminary evidence supporting the feasibility of UBE-PCF for single-level cervical decompression. Patients experienced short operative times, minimal hospitalization, and encouraging early improvements in PROMs. These findings contribute early clinical data on UBE-PCF and support larger prospective comparative studies with longer follow-up to better define its role.