Bone tunnel approach for cervical spondylotic radiculopathy with uncovertebral osteophytes

This study aimed to assess the clinical efficacy of posterior endoscopic surgery using a bone tunnel approach in treating cervical spondylotic radiculopathy (CSR) secondary to uncovertebral osteophytes.

From January 2022 to July 2023, 68 patients diagnosed with cervical osseous foraminal stenosis due to uncovertebral osteophytes and treated with posterior endoscopic surgery through the bone tunnel approach were retrospectively enrolled in this study, with a minimum follow-up period of 1 year. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and success rate according to Odom's criteria. Radiological outcomes were assessed by measuring the C2-7 sagittal Cobb angle (SCA), segmental angle (SA), and cervical curvature angle (CA) on the lateral, hyperflexion and hyperextension radiographs.

All the patients successfully underwent the procedure without severe complications. The mean operative duration was 84.1 ± 24.6 min, with an average hospital stay of 4.4 ± 2.2 days and a mean follow-up time of 14.7 ± 3.1 months. Significant improvements in the NDI and VAS scores were observed postoperatively (p < 0.05). At the final follow-up, the clinical success rate, defined as excellent or good outcomes, was 100% (43 excellent and 25 good outcomes). On lateral radiographs, no statistically significant differences were detected in SCA, CA, and SA measurements at various time points. On hyperextension radiographs, all measurements at the final follow-up were significantly larger than those taken pre- and postoperatively (p < 0.05). On hyperflexion radiographs, all postoperative measurements were significantly smaller than those taken preoperatively and at the final follow-up (p < 0.05).

Posterior endoscopic surgery through the bone tunnel approach is a safe and effective route for achieving direct neuroventral bony decompression, demonstrating favorable clinical and radiological outcomes in the treatment of CSR with uncovertebral osteophytes.