Efficacy evaluation of the cervical posterior “keyhole technique” in the treatment of cervical radiculopathy: A retrospective case series

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To evaluate the efficacy of endoscopic posterior keyhole decompression for cervical radiculopathy and to investigate the correlation between decompression parameters and clinical outcomes. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy traditionally requires anterior cervical discectomy and fusion (ACDF) or open posterior decompression. Although ACDF is the gold standard, it is associated with adjacent segment degeneration and implant-related complications. Minimally invasive posterior keyhole techniques aim to reduce surgical trauma; however, the optimal extent of decompression required for symptomatic relief remains unclear. METHODS: Forty patients with single-level cervical radiculopathy treated via unilateral endoscopic posterior keyhole decompression (strictly limited to targeted foraminotomy and partial medial facetectomy) (2021-2024) were reviewed. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Neck Disability Index (NDI) preoperatively, at discharge, and at 6 months postoperatively. Decompression parameters were quantified via postoperative CT. Statistical analysis included paired t-tests and Pearson correlation. RESULTS: All 40 procedures were successful. Specifically, 25 patients underwent isolated foraminotomy, and 15 received foraminotomy combined with discectomy, without any progression to interlaminar decompression or laminectomy. The mean operative time was 70.4 ± 24.7 minutes, and the mean blood loss was 11.7 ± 10.9 ml. Significant improvements in clinical scores were observed at all postoperative time points (P < 0.05). Statistical analysis revealed that neither the concurrent execution of a discectomy nor the diameter of the bony decompression window was significantly associated with the degree of postoperative symptom improvement. CONCLUSIONS: This study demonstrates that endoscopic posterior keyhole decompression is a safe and feasible technique that provides favorable short-term clinical outcomes with minimal surgical trauma. The findings strongly suggest that clinical efficacy depends on targeted neural decompression (determined by intraoperative nerve root mobility) rather than the maximal removal of disc tissue or extensive laminoforaminotomy.