Clinical outcomes of unilateral biportal endoscopic posterior cervical foraminotomy for single- and multilevel cervical spondylotic radiculopathy: a retrospective study

To investigate the clinical efficacy of Unilateral Biportal Endoscopic Posterior Cervical Foraminotomy (UBE-PCF) for single-level and multilevel cervical spondylotic radiculopathy (CSR). Thirty-seven patients who underwent UBE-PCF were retrospectively analysed and divided into single-level ( n = 14) and multilevel ( n = 23) groups. The mean follow-up was 19.27 ± 8.07 months. Perioperative indicators, clinical scores and cervical sagittal parameters, including the facet joint preservation rate, were compared. Sagittal parameters were measured by two blinded observers. Successful surgery was achieved in all cases in both groups without serious complications. The operation time of the multilevel group (138.61 ± 26.23 min) was significantly longer than that of the single-level group (115.07 ± 31.88 min) ( P = 0.029), as was the incision length ( P = 0.003), but no statistical difference was observed in the amount of visible and hidden blood loss between the two groups ( P > 0.05); At the last follow-up, the clinical efficacy scores of the two groups were significantly improved when compared with preoperative values ( P < 0.001). For the sagittal parameters, the magnitude of change from preoperative to postoperative did not differ significantly between the two groups for any parameter (all P ≥ 0.05). The C2-7 Cobb Angle was maintained in the single-level group (+ 1.00°, 95% CI − 2.62 to + 4.62, P = 0.561), whereas the multilevel group showed a small but significant within-group decrease (− 3.00°, 95% CI − 5.18 to − 0.82, P = 0.009); this decrease was smaller than the smallest detectable change for this measurement (4.11°), and the difference in change between the two groups did not reach significance ( P = 0.055). UBE-PCF is an effective and safe treatment for both single-level and multilevel CSR. Multilevel decompression was feasible but required a longer operation time and showed a small loss of cervical lordosis, without increased blood loss or complications. Given the retrospective design and small sample, these findings are preliminary and need prospective validation with dynamic imaging.