14. Cervical foraminal stenosis
@ProfFishchenkoCervical foraminal stenosis is narrowing of the intervertebral foramina through which spinal nerves exit the cervical spine. This narrowing may compress nerve roots, causing pain, numbness, tingling, or weakness in the neck, shoulders, arms, or fingers.
Causes:
• degenerative changes (osteochondrosis, facet joint osteoarthritis);
• formation of osteophytes (bony outgrowths);
• intervertebral disc herniations;
• ligament thickening;
• post-traumatic changes.
Symptoms:
• local neck pain;
• pain radiating into the shoulder or arm;
• numbness or tingling in the limbs;
• muscle weakness;
• in severe cases — impaired arm motor function.
This condition often progresses with age and may require conservative treatment (physiotherapy, medications) or surgical treatment (for example, foraminotomy or discectomy).
Anterior cervical discectomy and fusion (ACDF) provides decompression and stabilization, but eliminates movement at the operated segment and carries risks related to the anterior approach and implants, including scarring and esophageal irritation. Posterior endoscopic foraminotomy allows nerve root decompression without fusion, an anterior approach, or implant placement.
Biportal endoscopic spine surgery (BESS/UBE) allows targeted cervical foraminal decompression. Independent viewing and working portals permit flexible combinations of endoscope and instrument directions. This facilitates anatomical orientation and the use of familiar surgical instruments. The method combines the ability to decompress bony structures with a muscle-sparing approach. We choose BESS/UBE, another endoscopic technique, or ACDF according to the location of compression, segment condition, and clinical presentation.
References
1. Song KS, Lee CW. The biportal endoscopic posterior cervical inclinatory foraminotomy for cervical radiculopathy: technical report and preliminary results. Neurospine. 2020;17(Suppl 1):S145–S153.
2. Kim JY, et al. Comparative analysis of 3 types of minimally invasive posterior cervical foraminotomy for foraminal stenosis, uniportal-, biportal endoscopy, and microsurgery: radiologic and midterm clinical outcomes. Neurospine. 2022;19(1):212–223.
3. Lee SH, et al. Clinical outcomes and complications of unilateral biportal endoscopic posterior cervical foraminotomy: a systematic review and meta-analysis with a comparison to full-endoscopic posterior cervical foraminotomy. Neurospine. 2024;21(3):807–819.
4. Broekema AEH, et al. Noninferiority of posterior cervical foraminotomy vs anterior cervical discectomy with fusion for procedural success and reduction in arm pain among patients with cervical radiculopathy at 1 year: the FACET randomized clinical trial. JAMA Neurology. 2023;80(1):40–48.
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