Fully Endoscopic Posterior Cervical Foraminotomy: A Systematic Review of Clinical and Surgical Outcomes

Abstract

This study aims to systematically evaluate the clinical and surgical outcomes of fully endoscopic posterior cervical foraminotomy (FE-PCF) and to compare these results with open posterior cervical foraminotomy (PCF) benchmarks. Studies reporting on either fully endoscopic PCF or open PCF for cervical radiculopathy or degenerative disease were included. Primary outcomes included changes in pain and function, measured by patient reported outcomes. Secondary outcomes included surgical details, complications, and return to activity. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria and the Cochrane Risk of Bias tool for randomized trials. Across included studies, FE-PCF produced significant improvements in pain and function, with mean visual analog scale (VAS) arm reductions of 4 to 7 points, VAS neck reductions of 3 to 6 points, and neck disability index improvements of 15 to 30 points. By Macnab criteria, 80 to 95% achieved excellent or good outcomes. Complication rates were low, with transient neurological symptoms and minor dural tears most common. Reoperation rates were ≤5% at short- to mid-term follow-up. When benchmarked against open PCF, FE-PCF appears to offer comparable clinical outcomes, with a perioperative profile characterized by minimal blood loss and predominantly transient complications, though operative times were longer, particularly during the early learning curve. FE-PCF provides meaningful pain relief and functional improvement with a favorable safety profile in the short- to mid-term. While outcomes appear comparable to open PCF benchmarks, these comparisons remain indirect and limited by the small, retrospective nature of current studies. Until more definitive conclusions regarding durability, cost-effectiveness, and reproducibility emerge, FE-PCF should be considered a promising but still evolving motion-preserving alternative to open PCF.