Unilateral biportal endoscopic (UBE) posterior cervical foraminotomy utilizing intraoperative navigation: surgical technique

Unilateral cervical radiculopathy is a common pathology seen by spine surgeons and can be treated in a variety of ways. Traditional operative management of unilateral radiculopathy caused by disc herniation(s) has consisted of anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), or posterior cervical foraminotomy (PCF). Each approach carries with it unique challenges and potential complications ranging from dysphagia to vascular injury, post-operative bleeding, non-union, subsidence, and significant pain. PCF is a well-established motion-preserving treatment for unilateral radiculopathy without myelopathy that avoids fusion-related adjacent-segment disease and approach-related dysphagia. Unilateral biportal endoscopy (UBE) is being increasingly utilized as an ultra-minimally invasive technique for decompression in the cervical, thoracic, and lumbar spine. Applications of UBE in the cervical spine continue to expand and have shown great promise in the treatment of cervical radiculopathy arising from disc herniations causing unilateral symptoms. UBE-PCF is safe and effective and has been shown to produce lower early post-operative neck pain, reduced blood loss, and shorter operative time than microscopic PCF. We present the case of a 36-year-old male with left-sided C8 radiculopathy resulting from a left C7-T1 disc herniation that was successfully treated with UBE-PCF. This procedure was performed with the use of intraoperative navigation for accurate portal placement and anatomy verification. We describe our indications, operating room setup, and surgical technique in detail.