{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:48:57Z","timestamp":1771922937294,"version":"3.50.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical disc herniation with radiculopathy is a common cause of neck and arm pain. While anterior cervical discectomy and fusion (ACDF) remains the standard treatment, it sacrifices motion and may cause adjacent segment degeneration. Uniportal non-coaxial spinal endoscopic surgery (UNSES) offers a motion-preserving alternative. This case presents the first application of UNSES with endoscopic annular suture repair and ligamentum flavum suspension in the cervical spine, demonstrating its technical feasibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 54-year-old male presented with progressive neck and right right arm pain, numbness and triceps weakness, due to right paracentral C6\/C7 disc herniation compressing the C7 nerve root. The patient underwent full-endoscopic posterior cervical discectomy using a uniportal non-coaxial endoscopic system, with ligamentum flavum preservation via suture suspension. The annular defect was repaired intraoperatively using an endoscopic annular suture device under direct visualization. Postoperative imaging confirmed complete neural decompression and successful annular closure without residual disc or dural compromise. Postoperative MRI confirmed complete decompression and annular closure. At 3 months, visual analog scale (VAS) improved from 7 to 1, the Japanese Orthopaedic Association (JOA) score increased from 13 to 16, and the Neck Disability Index (NDI) decreased from 42% to 14%, with no recurrence or instability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>UNSES combined with annular suture repair enables safe, motion-preserving decompression for cervical disc herniation. This novel approach may enhance biomechanical integrity, reduce recurrence, and represent a minimally invasive alternative to fusion in selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1733374","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:54:17Z","timestamp":1769064857000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Uniportal non-coaxial endoscopic posterior cervical discectomy with annular suture repair for C6\/C7 disc herniation: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Yaoyu","family":"Xiang","sequence":"first","affiliation":[{"name":"Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Kunming Orthopedics Hospital","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Traditional Chinese Medicine Hospital of Luliang County","place":["Qujing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianguang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xidan","family":"Hu","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Center, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiqing","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yixiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"En","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University","place":["Kunming, Yunnan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1007\/s12178-016-9349-4","article-title":"Cervical radiculopathy","volume":"9","author":"Iyer","year":"2016","journal-title":"Curr Rev Musculoskelet Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1093\/brain\/117.2.325","article-title":"Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990","volume":"117","author":"Radhakrishnan","year":"1994","journal-title":"Brain"},{"key":"B3","doi-asserted-by":"publisher","first-page":"368","DOI":"10.5435\/00124635-199911000-00003","article-title":"Surgical management of cervical radiculopathy","volume":"7","author":"Albert","year":"1999","journal-title":"J Am Acad Orthop Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1053\/j.trap.2014.01.002","article-title":"Surgical treatment of cervical radiculopathy","volume":"17","author":"Hudson","year":"2013","journal-title":"Tech Reg Anesth Pain Manag"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2012\/916149","article-title":"Operative techniques for cervical radiculopathy and myelopathy","volume":"2012","author":"Moran","year":"2012","journal-title":"Adv Orthop"},{"key":"B6","doi-asserted-by":"publisher","first-page":"743","DOI":"10.31616\/asj.2024.0337","article-title":"Is minimally invasive surgery a game changer in spinal surgery?","volume":"18","author":"Park","year":"2024","journal-title":"Asian Spine J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/S1048-6666(03)00022-3","article-title":"Minimally invasive spinal surgery","volume":"13","author":"Shamie","year":"2003","journal-title":"Oper Tech Orthop"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e2136809","DOI":"10.1001\/jamanetworkopen.2021.36809","article-title":"Effectiveness of an annular closure device to prevent recurrent lumbar disc herniation: a secondary analysis with 5 years of follow-up","volume":"4","author":"Thom\u00e9","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.14245\/ns.2244344.172","article-title":"Full endoscopic ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression: surgical technique and clinical results","volume":"19","author":"Kwon","year":"2022","journal-title":"Neurospine"},{"key":"B10","first-page":"127","article-title":"Anterior cervical discectomy and fusion","author":"Grochulla","year":"2012"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e8663","DOI":"10.1097\/MD.0000000000008663","article-title":"Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion: incidence and risk factors","volume":"96","author":"Wang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1177\/21925682211055094","article-title":"Minimally invasive posterior cervical foraminotomy versus anterior cervical fusion and arthroplasty: systematic review and meta-analysis","volume":"12","author":"Platt","year":"2022","journal-title":"Glob Spine J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1007\/s00586-020-06637-8","article-title":"Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up","volume":"30","author":"Wu","year":"2021","journal-title":"Eur Spine J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"539","DOI":"10.4055\/cios22050","article-title":"Percutaneous full-endoscopic versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical foraminal disc disease","volume":"14","author":"Kang","year":"2022","journal-title":"Clin Orthop Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e42223","DOI":"10.1097\/MD.0000000000042223","article-title":"Arthroscopic-assisted uniportal spinal surgery with annular repair for lumbar disc herniation in hemophilia: a case report","volume":"104","author":"Xiang","year":"2025","journal-title":"Medicine (Baltimore)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"124026","DOI":"10.1016\/j.wneu.2025.124026","article-title":"Evaluation of hidden blood loss and clinical outcomes of arthroscopy-assisted uni-portal spinal surgery for lumbar disc herniation with lateral recess stenosis","volume":"198","author":"Zhou","year":"2025","journal-title":"World Neurosurg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s13018-024-04621-2","article-title":"Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study","volume":"19","author":"Wang","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1186\/s12891-025-08551-w","article-title":"Treatment of gas-containing lumbar disc cysts via a combination of posterior and extraforaminal approaches in arthroscopic-assisted uni-portal spine surgery: a case report and literature review","volume":"26","author":"Zhang","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"B19","doi-asserted-by":"publisher","first-page":"03000605241312828","DOI":"10.1177\/03000605241312828","article-title":"Arthroscopic-assisted uniportal spinal surgery for treatment of lumbar burst fractures complicated with neurological symptoms: a case report","volume":"53","author":"Chen","year":"2025","journal-title":"J Int Med Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1186\/s12891-025-08617-9","article-title":"Arthroscopic-assisted uni-portal non-coaxial endoscopic surgery treatment of fibrous dysplasia of the femur: a minimally invasive alternative to open surgery","volume":"26","author":"Luo","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2756","DOI":"10.1111\/os.70127","article-title":"AUSS assisted ACAF technique in the treatment of ossification of the posterior longitudinal ligament extending to the C2 segment","volume":"17","author":"Niu","year":"2025","journal-title":"Orthop Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"102","DOI":"10.2106\/00004623-200301000-00016","article-title":"Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence","volume":"85","author":"Carragee","year":"2003","journal-title":"J Bone Joint Surg Am"},{"key":"B23","doi-asserted-by":"publisher","first-page":"669","DOI":"10.2147\/JPR.S226480","article-title":"Clinical implications of vertebral endplate disruptions after lumbar discectomy: 3-year results from a randomized trial of a bone-anchored annular closure device","volume":"13","author":"Kur\u0161umovi\u0107","year":"2020","journal-title":"J Pain Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"5047","DOI":"10.1038\/s41598-025-89179-7","article-title":"Bone anchoring annular suture technique for repairing annular defects at vertebral body edge following lumbar discectomy","volume":"15","author":"Wang","year":"2025","journal-title":"Sci Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"E385","DOI":"10.1097\/01.BRS.0000085100.10349.15","article-title":"A ligamentum flavum-preserving approach to the lumbar spinal canal","volume":"28","author":"Askar","year":"2003","journal-title":"Spine"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e378","DOI":"10.1016\/j.wneu.2018.02.186","article-title":"Revisiting ligament-sparing lumbar microdiscectomy: when to preserve ligamentum flavum and how to evaluate radiological results for epidural fibrosis","volume":"114","author":"\u00d6zay","year":"2018","journal-title":"World Neurosurg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/S0090-3019(01)00677-2","article-title":"Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique","volume":"57","author":"Ayd\u0131n","year":"2002","journal-title":"Surg Neurol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.wneu.2020.09.033","article-title":"Thin cervical spinal cord between ossifications of the ligamentum flavum and the posterior longitudinal ligament: case report and literature review","volume":"145","author":"Ishikawa","year":"2021","journal-title":"World Neurosurg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1097\/01.brs.0000188117.77657.ee","article-title":"Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments","volume":"30","author":"Sairyo","year":"2005","journal-title":"Spine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"S74","DOI":"10.14245\/ns.2040166.083","article-title":"Posterior endoscopic cervical decompression: review and technical note","volume":"17","author":"Zhang","year":"2020","journal-title":"Neurospine"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1733374\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:43:27Z","timestamp":1771919007000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1733374\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":30,"alternative-id":["10.3389\/fsurg.2025.1733374"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1733374","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"article-number":"1733374"}}