Endoscopic Posterior Cervical Foraminotomy: 2-Dimensional Operative Video

In the 1940s, the posterior cervical foraminotomy (PCF) was first described. At that time, this technique represented a big step ahead for the treatment of cervical radiculopathy. Rightly, a multitude of studies demonstrated that open microsurgical posterior foraminotomy is an effective treatment for cervical radiculopathy. Open posterior approaches have still the disadvantage of detaching the extensor cervical muscles from the laminae and the spinous processes, which can lead to severe collateral tissue and muscle damage, followed by postoperative complications, such as axial neck pain, shoulder pain, loss of lordosis, or even spinal instability. Minimally invasive techniques have been developed to reduce the approach related trauma. Initially, these techniques have been performed using endoscopic visualization and applied to the lumbar spine with great success. With this in mind, spine surgeons have extended the spectrum of indication and applied endoscopic techniques to treat degenerative cervical spine disorders. Indications for PCF are single-level or multilevel unilateral lateral disc herniation, osseous foraminal stenosis secondary to isolated facet hypertrophy, and persistent radicular symptoms following an anterior cervical spine procedure. Depending on the underlying pathology, clinical success rates from 75% to 96% for the treatment of cervical radiculopathy have been reported. Mainly, there are 2 different endoscopic techniques to perform PCF. The so-called full-endoscopic techniques are performed under continuous irrigation in single-handed technique. The endoscopic tubular assisted technique is performed in bimanual fashion with microsurgical instruments. The purpose of this video is to describe the endoscopic tubular assisted technique in detail. Patient consent was obtained prior to preparation of the video.