{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:20:52Z","timestamp":1783005652979,"version":"3.54.5"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"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":"\n Background<\/jats:title>\n Unilateral biportal endoscopy (UBE) is increasingly used in cervical spine surgery, but comparative data against open-door laminoplasty (OD-L) for cervical myelopathy (CM) remain limited. This prospective observational study compared biportal endoscopic laminectomy (BE-L) with OD-L for multilevel CM, focusing on neurological recovery, perioperative burden, and sagittal alignment.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n From November 2022 to May 2024, 128 patients with 2\u20133 level CM were enrolled. Surgical approach followed patient preference. Propensity score matching (1:1) based on age, sex, BMI, preoperative mJOA, operated levels, and C2\u2013C7 Cobb angle produced 50 matched pairs. Primary outcome was\n \n \n \u0394<\/mml:mi>\n <\/mml:math>\n <\/jats:inline-formula>\n mJOA at 12 months. Secondary outcomes included NDI, VASneck, operative time, hospital stay, perioperative hemoglobin (Hb) drop, and sagittal alignment parameters. Because cSVA and T1 slope were not included in the original matching model, a post-hoc sensitivity analysis was performed to verify baseline comparability of these variables.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After matching, baseline characteristics were well balanced. Sensitivity analysis confirmed no significant differences between groups in cSVA (\n \n \n 23.1<\/mml:mn>\n \u00b1<\/mml:mo>\n 6.9<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n vs.\n \n \n 24.8<\/mml:mn>\n \u00b1<\/mml:mo>\n 7.0<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n \u2009mm,\n \n \n P<\/mml:mi>\n =<\/mml:mo>\n 0.224<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ) or T1 slope (\n \n \n 25.0<\/mml:mn>\n \u00b1<\/mml:mo>\n \n 5.7<\/mml:mn>\n \n \u2218<\/mml:mo>\n <\/mml:mrow>\n <\/mml:msup>\n <\/mml:math>\n <\/jats:inline-formula>\n vs.\n \n \n 26.5<\/mml:mn>\n \u00b1<\/mml:mo>\n \n 6.0<\/mml:mn>\n \n \u2218<\/mml:mo>\n <\/mml:mrow>\n <\/mml:msup>\n <\/mml:math>\n <\/jats:inline-formula>\n ,\n \n \n P<\/mml:mi>\n =<\/mml:mo>\n 0.203<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ). BE-L was associated with shorter operative time (\n \n \n 88.7<\/mml:mn>\n \u00b1<\/mml:mo>\n 13.8<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n vs.\n \n \n 146.5<\/mml:mn>\n \u00b1<\/mml:mo>\n 18.4<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n \u2009min,\n \n \n P<\/mml:mi>\n <<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ), lower perioperative Hb drop (\n \n \n 0.62<\/mml:mn>\n \u00b1<\/mml:mo>\n 0.35<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n vs.\n \n \n 1.98<\/mml:mn>\n \u00b1<\/mml:mo>\n 0.72<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n \u2009g\/dL,\n \n \n P<\/mml:mi>\n <<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ), and shorter hospital stay (\n \n \n 2.6<\/mml:mn>\n \u00b1<\/mml:mo>\n 1.2<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n vs.\n \n \n 7.2<\/mml:mn>\n \u00b1<\/mml:mo>\n 1.6<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n days,\n \n \n P<\/mml:mi>\n <<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ). At 3 months,\n \n \n \u0394<\/mml:mi>\n <\/mml:math>\n <\/jats:inline-formula>\n mJOA favored BE-L (mean difference 0.70,\n \n \n P<\/mml:mi>\n =<\/mml:mo>\n 0.015<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ), but this difference fell below the minimal clinically important difference of 2 points and was not maintained at 6 or 12 months, indicating comparable long-term neurological recovery. Early NDI and VASneck scores favored BE-L, converging by 12 months. No significant differences in C2\u2013C7 Cobb angle were observed at any time point. Four transient neurological deficits occurred in the BE-L group during the initial learning curve; no further events occurred after refinement of hydrostatic pressure management.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n BE-L achieves 12-month neurological and functional outcomes comparable to those of OD-L, with advantages in early postoperative recovery and shorter hospitalization. No statistically significant difference was detected at the primary endpoint. BE-L represents a viable minimally invasive alternative for carefully selected patients with 2\u20133 level CM.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1835786","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:11:19Z","timestamp":1783005079000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biportal endoscopic laminectomy vs. open-door laminoplasty for 2\u20133 levels of cervical myelopathy: a prospective observational cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dongfang","family":"Yang","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dalian Municipal Central Hospital 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