{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:50:37Z","timestamp":1791334237764,"version":"4.3.1"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Biportal endoscopic posterior cervical foraminotomy (BE-PCF) has gained popularity as a minimally invasive technique for the treatment of unilateral cervical radiculopathy. Although BE-PCF is expected to reduce tissue injury while providing effective neural decompression, long-term comparative data with minimally invasive microscopic PCF are limited. The aim of this study was to compare clinical outcomes, perioperative parameters, and tissue injury profiles between patients who underwent BE-PCF and those who underwent microscopic PCF with a minimum 2-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective comparative study included 126 patients who underwent single-level PCF (69 with BE-PCF and 57 with microscopic PCF). Clinical outcomes were assessed using visual analog scale (VAS) scores for neck and arm pain and the Neck Disability Index (NDI). Perioperative variables, complications, and reoperation rates were analyzed. Muscle and soft tissue injury were evaluated using serum biomarkers, including creatine phosphokinase (CPK) and C-reactive protein (CRP) levels, and MRI-based muscle injury scoring. Radiological assessment included postoperative MRI and dynamic radiography for instability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Both procedure groups showed significant improvement in VAS and NDI scores at the final follow-up. The BE-PCF group demonstrated significantly lower neck pain at postoperative day 1 and at the final follow-up. There were no significant differences in arm pain or functional outcomes between groups. Estimated blood loss was significantly lower in the BE-PCF group. Postoperative increases in CPK and CRP levels were significantly higher in the microscopic PCF group, indicating greater muscle and soft tissue injury. MRI-based muscle injury scores were also significantly lower in the BE-PCF group. Complication and reoperation rates were comparable between the two groups, and no postoperative instability was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>BE-PCF provides clinical outcomes comparable with that of microscopic PCF while significantly reducing muscle and soft tissue injury. These findings suggest that BE-PCF is a safe and effective minimally invasive alternative for the treatment of unilateral cervical radiculopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.7.focus26352","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:05:09Z","timestamp":1790121909000},"page":"E18","source":"Crossref","is-referenced-by-count":0,"title":["Comparative study of biportal endoscopic and microscopic posterior cervical foraminotomy: clinical and radiological outcomes with minimum 2-year follow-up"],"prefix":"10.3171","volume":"61","author":[{"given":"Dong Hwa","family":"Heo","sequence":"first","affiliation":[{"name":"Endoscopic Spine Surgery Center, Neurosurgery, Chungdam Harrison Spinartus Hospital, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Hyub","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Chan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Anyang Wiltse Memorial Hospital, Anyang, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Won","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"7","key":"b1","series-title":"Global Spine J","first-page":"1573","article-title":"Minimally invasive posterior cervical foraminotomy versus anterior cervical fusion and arthroplasty: systematic review and meta-analysis","volume":"12","author":"Platt A","year":"2022","unstructured":"Platt A, Fessler RG, Traynelis VC, O\u2019Toole JE. Minimally invasive posterior cervical foraminotomy versus anterior cervical fusion and arthroplasty: systematic review and meta-analysis. Global Spine J. 2022;12(7):1573\u20131582. doi:10.1177\/21925682211055094"},{"issue":"2","key":"b2","series-title":"Neurosurg Focus Video","first-page":"V12","article-title":"Biportal endoscopic posterior cervical foraminotomy with discectomy for unilateral radicular arm pain due to cervical herniated disc","volume":"10","author":"Heo DH","year":"2024","unstructured":"Heo DH. Biportal endoscopic posterior cervical foraminotomy with discectomy for unilateral radicular arm pain due to cervical herniated disc. Neurosurg Focus Video. 2024;10(2):V12. doi:10.3171\/2024.1.FOCVID23225"},{"issue":"1","key":"b3","series-title":"Neurospine","first-page":"92","article-title":"Biportal endoscopic posterior cervical foraminotomy for adjacent 2-level foraminal lesions using a single approach (sliding technique)","volume":"20","author":"Heo DH","year":"2023","unstructured":"Heo DH, Ha JS, Jang JW. Biportal endoscopic posterior cervical foraminotomy for adjacent 2-level foraminal lesions using a single approach (sliding technique). Neurospine. 2023;20(1):92\u201398. doi:10.14245\/ns.2346144.072"},{"key":"b4","series-title":"World Neurosurg","first-page":"148","article-title":"Narrative review of uniportal posterior endoscopic cervical foraminotomy","volume":"181","author":"Kim HS","year":"2024","unstructured":"Kim HS, Wu PH, Tze-Chun Lau E, Jang IT. Narrative review of uniportal posterior endoscopic cervical foraminotomy. World Neurosurg. 2024;181:148\u2013153. doi:10.1016\/j.wneu.2023.10.021"},{"issue":"5 Suppl","key":"b5","series-title":"Neurosurgery","first-page":"S37","article-title":"Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience","volume":"51","author":"Fessler RG","year":"2002","unstructured":"Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery. 2002;51(5 Suppl):S37\u2013S45. doi:10.1097\/00006123-200211002-00006"},{"issue":"3","key":"b6","series-title":"Spine J","first-page":"467","article-title":"History of endoscopic spine surgery: where did it all begin? Development of indications and techniques","volume":"26","author":"Heo DH","year":"2026","unstructured":"Heo DH, Kim HS, Whang YH, Lee DC, Lim K. History of endoscopic spine surgery: where did it all begin? Development of indications and techniques. Spine J. 2026;26(3):467\u2013478. doi:10.1016\/j.spinee.2025.07.031"},{"issue":"3","key":"b7","series-title":"Neurospine","first-page":"603","article-title":"Comparative analysis with modified inclined technique for posterior endoscopic cervical foraminotomy in treating cervical osseous foraminal stenosis: radiological and midterm clinical outcomes","volume":"19","author":"Kim JY","year":"2022","unstructured":"Kim JY, Heo DH, Lee DC, Kim TH, Park CK. Comparative analysis with modified inclined technique for posterior endoscopic cervical foraminotomy in treating cervical osseous foraminal stenosis: radiological and midterm clinical outcomes. Neurospine. 2022;19(3):603\u2013615. doi:10.14245\/ns.2244268.134"},{"issue":"3","key":"b8","series-title":"J Neurosurg Spine","first-page":"330","article-title":"A retrospective comparative analysis of postoperative opioid utilization following uniportal endoscopic versus minimally invasive versus open approaches for posterior cervical foraminotomy","volume":"44","author":"Ansari D","year":"2026","unstructured":"Ansari D, Greeneway GP, Talbot G, Brooks NP. A retrospective comparative analysis of postoperative opioid utilization following uniportal endoscopic versus minimally invasive versus open approaches for posterior cervical foraminotomy. J Neurosurg Spine. 2026;44(3):330\u2013339. doi:10.3171\/2025.8.SPINE25515"},{"issue":"1","key":"b9","series-title":"J Clin Med","first-page":"164","article-title":"Comparison of open microscopic and biportal endoscopic approaches in multi-level posterior cervical foraminotomy: radiological and clinical outcomes","volume":"14","author":"Lee HR","year":"2024","unstructured":"Lee HR, Park JM, Kim IH, Kim JH, Yang JH. Comparison of open microscopic and biportal endoscopic approaches in multi-level posterior cervical foraminotomy: radiological and clinical outcomes. J Clin Med. 2024;14(1):164. doi:10.3390\/jcm14010164"},{"issue":"1","key":"b10","series-title":"Neurosurg Rev","first-page":"803","article-title":"Comparative efficacy of unilateral biportal endoscopic and full-endoscopic posterior cervical foraminotomy in the treatment of cervical spondylotic radiculopathy: a retrospective analysis","volume":"47","author":"Tang Z","year":"2024","unstructured":"Tang Z, Jian L, Liu Y,  Comparative efficacy of unilateral biportal endoscopic and full-endoscopic posterior cervical foraminotomy in the treatment of cervical spondylotic radiculopathy: a retrospective analysis. Neurosurg Rev. 2024;47(1):803. doi:10.1007\/s10143-024-03046-z"},{"issue":"2","key":"b11","series-title":"J Neurosurg Spine","first-page":"181","article-title":"Biportal endoscopic multisegment decompression laminectomy for cervical spondylotic myelopathy","volume":"43","author":"Kim JY","year":"2025","unstructured":"Kim JY, Heo DH, Choi SY, Lee DC, Kwon HC. Biportal endoscopic multisegment decompression laminectomy for cervical spondylotic myelopathy. J Neurosurg Spine. 2025;43(2):181\u2013189. doi:10.3171\/2025.2.SPINE241142"},{"issue":"9","key":"b12","series-title":"Eur Spine J","first-page":"1567","article-title":"Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study","volume":"20","author":"Okada E","year":"2011","unstructured":"Okada E, Matsumoto M, Ichihara D,  Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study. Eur Spine J. 2011;20(9):1567\u20131573. doi:10.1007\/s00586-011-1774-x"},{"issue":"8","key":"b13","series-title":"Eur Spine J","first-page":"2853","article-title":"Enhanced recovery after surgery pathway with modified biportal endoscopic transforaminal lumbar interbody fusion using a large cage. Comparative study with minimally invasive microscopic transforaminal lumbar interbody fusion","volume":"32","author":"Heo DH","year":"2023","unstructured":"Heo DH, Jang JW, Park CK. Enhanced recovery after surgery pathway with modified biportal endoscopic transforaminal lumbar interbody fusion using a large cage. Comparative study with minimally invasive microscopic transforaminal lumbar interbody fusion. Eur Spine J. 2023;32(8):2853\u20132862. doi:10.1007\/s00586-023-07747-9"},{"key":"b14","series-title":"World Neurosurg","first-page":"411","article-title":"Indications, contraindications, and complications of biportal endoscopic decompressive surgery for the treatment of lumbar stenosis: a systematic review","volume":"168","author":"Heo DH","year":"2022","unstructured":"Heo DH, Park DY, Hong HJ, Hong YH, Chung H. Indications, contraindications, and complications of biportal endoscopic decompressive surgery for the treatment of lumbar stenosis: a systematic review. World Neurosurg. 2022;168:411\u2013420. doi:10.1016\/j.wneu.2022.09.023"},{"issue":"8","key":"b15","series-title":"Eur Spine J","first-page":"2769","article-title":"Temperature change of epidural space by radiofrequency use in biportal endoscopic lumbar surgery: safety evaluation of radiofrequency","volume":"32","author":"Heo DH","year":"2023","unstructured":"Heo DH, Park DY, Hong YH, Kim D, Kim JS. Temperature change of epidural space by radiofrequency use in biportal endoscopic lumbar surgery: safety evaluation of radiofrequency. Eur Spine J. 2023;32(8):2769\u20132775. doi:10.1007\/s00586-023-07719-z"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/4\/article-pE18.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/4\/article-pE18.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/4\/article-pE18.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:43Z","timestamp":1791331243000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/4\/article-pE18.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":15,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2026.7.focus26352","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}