Uniportal Endoscopic Versus Biportal Endoscopic Versus Microscopic/Tubular Posterior Cervical Foraminotomy: A Structured Debate and International Practice Patterns

This structured debate integrates a narrative evidence synthesis with an international practice-pattern survey comparing uniportal endoscopic cervical foraminotomy (PECF), unilateral biportal endoscopic cervical foraminotomy (UBE-CF), and microscopic/tubular posterior cervical foraminotomy. The literature search covered January 1990 to July 5, 2026. Comparative evidence was predominantly retrospective, single-center, and heterogeneous. Background and expertise data were available for 75 respondents, including 74 with endoscopic expertise, and 73 completed all 4 clinical scenarios. Uniportal-only respondents predominantly selected PECF, whereas biportal-only respondents favored UBE-CF. Treatment choices differed across the predefined clinical scenarios, with anterior cervical discectomy and fusion (ACDF) selected by 19 of 73 (26.0%), 35 of 73 (47.9%), 19 of 73 (26.0%), and 49 of 73 respondents (67.1%) in cases 1–4, respectively. These scenarios changed several clinical features simultaneously and do not establish the independent influence of any single feature. Available comparative studies have not established durable superiority of one posterior technique over another. ACDF was the most frequently selected single procedure in the scenario combining retrolisthesis, asymptomatic central stenosis, and motor weakness (case 2) and in the revision scenario (case 4). Platform selection should reflect surgeon expertise, anatomy, and available resources. Multicenter randomized or expertise-based comparative trials with standardized outcomes and long-term follow-up are needed.

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Journal
Neurospine
Published
2026-10-29
DOI
https://doi.org/10.14245/ns.26521630.0815
Citations
1
Primary Topic
Cervical and Thoracic Myelopathy
Type
article
Field-Weighted Citation Impact
6.31
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article

Uniportal Endoscopic Versus Biportal Endoscopic Versus Microscopic/Tubular Posterior Cervical Foraminotomy: A Structured Debate and International Practice Patterns

Florian Wanivenhaus, Christian Morgenstern, Enrico Giordan, Jae‐Joong Kim et al.
1 citations
Neurospine
Cervical and Thoracic Myelopathy
6.31
article

Uniportal Endoscopic Versus Biportal Endoscopic Versus Microscopic/Tubular Posterior Cervical Foraminotomy: A Structured Debate and International Practice Patterns

Florian Wanivenhaus, Christian Morgenstern, Enrico Giordan, Jae‐Joong Kim, Mazda Farshad, Meng–Huang Wu, Weerasak Singhatanadgige, Hamdi Öztürk, Jean–Yves Fournier, Khanathip Jitpakdee, Rafael Lindi Sugino, Hussam Essam Jabri, Asrafi Rizki Gatam, Suthipas Pongmanee, Vit Kotheeranurak, Piya Chavalparit, Pius Kim, Woo‐Keun Kwon, Ahmed Alqatub, Chang Kyu Lee, Ahmed Ibrahim, Saqib Hasan, Xuexiao Ma
article en
1 citations

Abstract

This structured debate integrates a narrative evidence synthesis with an international practice-pattern survey comparing uniportal endoscopic cervical foraminotomy (PECF), unilateral biportal endoscopic cervical foraminotomy (UBE-CF), and microscopic/tubular posterior cervical foraminotomy. The literature search covered January 1990 to July 5, 2026. Comparative evidence was predominantly retrospective, single-center, and heterogeneous. Background and expertise data were available for 75 respondents, including 74 with endoscopic expertise, and 73 completed all 4 clinical scenarios. Uniportal-only respondents predominantly selected PECF, whereas biportal-only respondents favored UBE-CF. Treatment choices differed across the predefined clinical scenarios, with anterior cervical discectomy and fusion (ACDF) selected by 19 of 73 (26.0%), 35 of 73 (47.9%), 19 of 73 (26.0%), and 49 of 73 respondents (67.1%) in cases 1–4, respectively. These scenarios changed several clinical features simultaneously and do not establish the independent influence of any single feature. Available comparative studies have not established durable superiority of one posterior technique over another. ACDF was the most frequently selected single procedure in the scenario combining retrolisthesis, asymptomatic central stenosis, and motor weakness (case 2) and in the revision scenario (case 4). Platform selection should reflect surgeon expertise, anatomy, and available resources. Multicenter randomized or expertise-based comparative trials with standardized outcomes and long-term follow-up are needed.

NeurospineVol. 23(4)
Izmir University (TR), Riyadh Armed Forces Hospital (SA), Chosun University (KR), Imperial College Healthcare NHS Trust (GB), Chulalongkorn University (TH), Yonsei University (KR), University of Zurich (CH), Navamindradhiraj University (TH), Severance Hospital (KR), Hospital Israelita Albert Einstein (BR), Vajira Hospital (TH), King Chulalongkorn Memorial Hospital (TH), Taipei Medical University Hospital (TW), Hospital Quirón Teknon (ES), AULSS 2 Marca Trevigiana (IT), Chosun University Hospital (KR), Affiliated Hospital of Qingdao University (CN), Universitätsklinik Balgrist (CH), Hôpital de Sion (CH), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Yonsei University Health System (KR), Fatmawati Hospital (ID), Korea University Guro Hospital (KR), Queen Savang Vadhana Memorial Hospital (TH), Taipei Medical University (TW), Chiang Mai University (TH), Catholic University of Korea (KR)
Good health and well-being
Openalex Percentile: Top 3%
Cervical and Thoracic Myelopathy
6.31
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