Anchored Drill-Assisted Localization for Percutaneous Endoscopic Cervical Keyhole Surgery in the Treatment of Cervical Spondylotic Radiculopathy: A Technical Report and Preliminary Efficacy Evaluation

Objectives: This study presents a novel anchored drill-assisted localization technique for percutaneous endoscopic cervical keyhole surgery in single-level cervical spondylotic radiculopathy (CSR). This technical report describes its feasibility, preliminary efficacy, and safety. Methods: We retrospectively analyzed 40 consecutive patients with single-level CSR treated with this technique (July 2023–August 2025). Operative time, blood loss, hospital stay, and complications were recorded. Decompression safety was evaluated on postoperative computed tomography (CT) by measuring the distance between the bone resection margin and the intervertebral foramen. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain, the Japanese Orthopaedic Association (JOA) score, the Neck Disability Index (NDI), and modified MacNab criteria. Results: No major complications occurred. Minor complications included transient axial neck pain in 3 patients (7.5%) and persistent axial neck pain in 1 patient (2.5%). After a median follow-up of 15.2 (12.2–26.1) months, all clinical scores improved significantly (all p < 0.001). The mean JOA score increased from 13.8 ± 2.0 to 16.5 ± 1.1, and mean NDI decreased from 45.6 ± 8.9% to 9.8 ± 8.2%. Neck and arm VAS decreased from 5.4 ± 1.8 and 5.4 ± 2.1 to 0.7 ± 1.2 and 0.8 ± 1.0, respectively. The excellent/good rate by modified MacNab criteria was 97.5% (39/40). Conclusions: The anchored drill-assisted technique may enhance spatial orientation, potentially reduce fluoroscopy use, and establishes a clear safety boundary. This preliminary report demonstrates favorable safety and efficacy in treating single-level CSR. Prospective comparative studies are warranted.