{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T08:10:26Z","timestamp":1780387826098,"version":"3.54.1"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Mixed\u2010type cervical spondylosis (MCS) refers to a degenerative disease in which multiple structures of the cervical spine are affected. Achieving adequate multi\u2010site decompression with minimal muscle dissection is technically demanding in cervical spine surgery. This study aims to evaluate the feasibility of one\u2010stage decompression for MCS with multi\u2010site lesions utilizing biportal endoscopic spinal surgery (BESS). A combined approach involving keyhole foraminotomy and unilateral laminotomy for bilateral decompression (Keyhole\u2010ULBD) was proposed and applied in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study was designed as a technical descriptive study. Patients diagnosed with MCS who underwent Keyhole\u2010ULBD using the BESS technique between October 2022 and June 2024 were enrolled. Demographic characteristics and baseline clinical data were collected. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and modified Japanese Orthopedic Association (mJOA) scores at 1, 6, and 12\u2009months postoperatively. Radiological parameters were measured to assess the extent of decompression and cervical stability. Paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test and Wilcoxon signed\u2010rank test were applied to compare preoperative and postoperative measurements, with statistical significance set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 12 MCS patients were enrolled. Compared with preoperative values, there was a significant increase in foraminal area (from 0.19\u2009\u00b1\u20090.06 to 0.25\u2009\u00b1\u20090.06\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      ) and spinal canal area (from 1.36\u2009\u00b1\u20090.21 to 2.75\u2009\u00b1\u20090.48\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      ), as well as a marked improvement in VAS\u2010neck scores (from 5.00\u2009\u00b1\u20091.67 to 1.50\u2009\u00b1\u20090.55) and mJOA scores (from 12.01\u2009\u00b1\u20092.19 to 15.83\u2009\u00b1\u20091.83) at 1\u2009month postoperatively. At the 1\u2010year follow\u2010up, both radiological decompression and improvements in pain and functional outcomes were sustained, demonstrating stable long\u2010term clinical efficacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Keyhole\u2010ULBD technique offers a safe and effective approach for one\u2010stage decompression in MCS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70320","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:09:50Z","timestamp":1775884190000},"page":"1278-1287","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Keyhole Foraminotomy Combined With Unilateral Laminotomy for Bilateral Decompression Under Biportal Endoscopic Spinal Surgery for the Treatment of Mixed\u2010Type Cervical Spondylosis"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1867-1323","authenticated-orcid":false,"given":"Lejian","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7062-8088","authenticated-orcid":false,"given":"Xiaowei","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6935-7651","authenticated-orcid":false,"given":"Xiaowen","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2779-0176","authenticated-orcid":false,"given":"Tianxin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danlei","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9737-6108","authenticated-orcid":false,"given":"Zhuolin","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5114-5096","authenticated-orcid":false,"given":"Yongzhi","family":"Jian","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6727-9231","authenticated-orcid":false,"given":"Qingfeng","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University  Yiwu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"issue":"2","key":"e_1_2_10_2_1","first-page":"78","article-title":"Cervical Spondylosis: Recognition, Differential Diagnosis, and Management","volume":"3","author":"Voorhies R. 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I.","year":"1999","journal-title":"Journal of Neurosurgery"},{"issue":"3","key":"e_1_2_10_24_1","first-page":"37099","article-title":"Pathoanatomy, Biomechanics, and Treatment of Upper Cervical Ligamentous Instability: A Literature Review","volume":"14","author":"Vij N.","year":"2022","journal-title":"Orthopedic Reviews (Pavia)"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000001722"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2022.04.112"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000001071"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1227\/ons.0000000000000629"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-024-05965-8"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70320","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.70320","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T07:44:09Z","timestamp":1780386249000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":28,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/os.70320"],"URL":"https:\/\/doi.org\/10.1111\/os.70320","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]},"assertion":[{"value":"2025-10-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}