Novel endoscopic hybrid technique in the treatment of cervical spondylotic radiculopathy

This is a retrospective study on endoscopic treatment of cervical spinal radiculopathy (CSR) conducted at a single academic institution. Conventional full-spine endoscopy is performed in a single portal which has certain limitations of high technical requirements, steep learning curve, and narrow indications. Although unilateral biportal endoscopy (UBE) technique has a gentle learning curve and is gradually applied to treat CSR, all procedures were performed in the uniportal working channel that potentially increase the surgical risk and time in the treatment of complex cases. It is worthy to delve novel technique for more working channels in the treatment of complex CSR.

To propose a hybrid technique (HT) that utilizes spine endoscopy in UBE to treatment of CSR.

A total of 81 patients with single-segment CSR who underwent uniportal endoscopic surgery (UES), UBE, or HT at a single institution between September 2019 and August 2021 were retrospectively studied. Perioperative patient data were compared between the groups. The pre-operative and post-operative images were compared to confirm adequate decompression of the nerve root canal. Patients' visual analogue scale (VAS) scores and neck disability index (NDI) were recorded before surgery, and three days, three months and six months after surgery.

The UBE and HT groups had a significantly shorter operation duration than the UES group. Data for bleeding and length of hospital stay were significantly higher in the UBE group than in the UES and HT groups. The hospitalization cost was lowest in the UES group and highest in the HT group. Soft tissue edema reaction bands on post-operative day 3 were larger in the UBE and HT groups than in the UES group. Post-operative VAS and NDI scores were significantly lower in all three groups than the pre-operative levels. On post-operative day 3, the VAS score for neck pain was significantly higher in the UBE and HT groups than that in the UES group. However, there were no significant differences in the VAS scores for arm pain or NDI between the three groups. The post-operative 3-month and 6-month neck pain VAS, arm pain VAS, NDI, and modified Macnab success rates did not differ statistically between the three groups.

The HT for CSR treatment has the advantage of double working channels to facilitate decompression and hemostasis, improving the surgical efficiency and clinical outcomes of CSR.