Juxta-Midline Subperiosteal Approach – A Modified Unilateral Biportal Endoscopic Posterior Cervical Foraminotomy: A Technical Note

Abstract: Background: Posterior biportal endoscopic cervical foraminotomy requires para median muscle splitting due to the absence of the lumbar “Son’s fat space” in the cervical spine. Technical Note: We propose a modified juxta-midline approach to create a subperiosteal corridor using incisions placed next to the spinous process and subperiosteal muscle stripping to create a continuous working space while avoiding muscle splitting or cutting. Results and Conclusions: This modification reduces docking hemorrhage, optimizes fluid flow space, and simplifies fluoroscopy.