{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:05:06Z","timestamp":1779890706468,"version":"3.53.1"},"reference-count":27,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Posterior endoscopic cervical foraminotomy is an established motion-preserving procedure for selected patients with unilateral cervical radiculopathy. However, isolated foraminal decompression may be insufficient in cases with concomitant foraminal stenosis and lateral soft disk herniation. This preliminary study evaluated clinical outcomes and quantitative MRI changes after combined posterior endoscopic cervical diskectomy and foraminotomy (CEDF) and explored the relationship between postoperative foraminal enlargement and clinical improvement. Methods: This retrospective single-center exploratory cohort study included 15 consecutive patients with single-level unilateral cervical radiculopathy caused by combined foraminal stenosis and lateral soft disc herniation who were treated between 2021 and 2023. All patients underwent CEDF using a posterior full-endoscopic approach. Clinical outcomes were assessed preoperatively, at 6 weeks, and at 12 months using the Visual Analog Scale for arm and neck pain, the Neck Disability Index, and modified MacNab criteria. Quantitative MRI assessment included minimal foraminal diameter, Foraminal Symmetry Index (FSI), and Quantitative Cervical Expansion (QCE). Correlations between radiological and clinical outcomes were analyzed as exploratory, hypothesis-generating analyses. Results: Mean minimal foraminal diameter increased from 1.9 \u00b1 0.7 mm preoperatively to 4.1 \u00b1 0.8 mm postoperatively, with improvement in FSI from 0.40 \u00b1 0.12 to 0.89 \u00b1 0.11. Significant clinical improvement was observed across all outcome measures. Mean arm pain decreased from 7.2 \u00b1 1.3 preoperatively to 1.3 \u00b1 1.4 at final follow-up, while NDI improved from 48.0 \u00b1 14.0% to 18.3 \u00b1 12.0%. The minimum clinically important difference for arm pain reduction was achieved in 14 of 15 patients. A moderate positive exploratory association was observed between foraminal enlargement and reduction in arm pain severity. No major neurological complications, postoperative instability, or revision procedures were observed in this small cohort during the available follow-up. Conclusions: In this preliminary retrospective single-center cohort, CEDF was associated with clinical improvement and measurable postoperative foraminal enlargement in carefully selected patients with unilateral cervical radiculopathy caused by combined foraminal stenosis and lateral soft disc herniation. The observed association between foraminal enlargement and arm pain reduction should be interpreted cautiously because of the small sample size and exploratory design. QCE and FSI should be regarded as preliminary quantitative radiological indices rather than validated markers of decompression adequacy or clinical response. Larger prospective comparative studies are required to validate these findings and define the role of CEDF among established cervical decompression procedures.<\/jats:p>","DOI":"10.3390\/jcm15114129","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:31:56Z","timestamp":1779885116000},"page":"4129","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preliminary Quantitative MRI Assessment After Combined Posterior Endoscopic Cervical Discectomy and Foraminotomy: An Exploratory Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7134-3129","authenticated-orcid":false,"given":"Tomasz","family":"Sienkiel","sequence":"first","affiliation":[{"name":"Department of Orthopedics, University Orthopedic and Rehabilitation Hospital, 34-500 Zakopane, Poland"},{"name":"Department of Orthopedics, Medical College, Jagiellonian University, 31-008 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7152-2012","authenticated-orcid":false,"given":"Barbara","family":"Jasiewicz","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Orthopedic and Rehabilitation Hospital, 34-500 Zakopane, Poland"},{"name":"Department of Orthopedics, Medical College, Jagiellonian University, 31-008 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Taterra","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Orthopedic and Rehabilitation Hospital, 34-500 Zakopane, Poland"},{"name":"Department of Orthopedics, Medical College, Jagiellonian University, 31-008 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"G\u0105ska","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Orthopedic and Rehabilitation Hospital, 34-500 Zakopane, Poland"},{"name":"Department of Orthopedics, Medical College, Jagiellonian University, 31-008 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw","family":"Koszyk","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Orthopedic and Rehabilitation Hospital, 34-500 Zakopane, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klemens","family":"Machajewski","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital in Krak\u00f3w, 30-688 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"G\u0105dek","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Medical College, Jagiellonian University, 31-008 Krak\u00f3w, Poland"},{"name":"Department of Orthopedics and Traumatology, University Hospital in Krak\u00f3w, 30-688 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.2106\/JBJS.23.00775","article-title":"Posterior cervical foraminotomy compared with anterior cervical discectomy with fusion for cervical radiculopathy: Two-year results of the FACET randomized noninferiority study","volume":"106","author":"Broekema","year":"2024","journal-title":"J. Bone Jt. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/os.12285","article-title":"Comparison of anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of cervical radiculopathy: A systematic review","volume":"8","author":"Liu","year":"2016","journal-title":"Orthop. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"344","DOI":"10.3171\/2019.9.SPINE19787","article-title":"Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: Up to 5 years of outcome from the national Swedish Spine Register","volume":"32","author":"MacDowall","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1097\/BRS.0000000000003156","article-title":"Minimally invasive posterior cervical foraminotomy as an alternative to anterior cervical discectomy and fusion for unilateral cervical radiculopathy: A systematic review and meta-analysis","volume":"44","author":"Sahai","year":"2019","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/BSD.0000000000001327","article-title":"Microscopic anterior cervical discectomy and fusion versus posterior percutaneous endoscopic cervical keyhole foraminotomy for single-level unilateral cervical radiculopathy: A systematic review and meta-analysis","volume":"36","author":"Guo","year":"2023","journal-title":"Clin. Spine Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1097\/BRS.0b013e31816c8b67","article-title":"Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: A prospective, randomized, controlled study","volume":"33","author":"Ruetten","year":"2008","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e24.00003","DOI":"10.2106\/JBJS.ST.24.00003","article-title":"Endoscopic posterior cervical foraminotomy and discectomy","volume":"15","author":"Raad","year":"2025","journal-title":"JBJS Essent. Surg. Tech."},{"key":"ref_8","first-page":"15S","article-title":"Clinical outcomes and future directions of endoscopic cervical spine surgery: A systematic review with narrative insights","volume":"16","author":"Wang","year":"2026","journal-title":"Glob. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1016\/j.wneu.2018.07.141","article-title":"Posterior percutaneous endoscopic cervical diskectomy: A single-center experience of 252 cases","volume":"120","author":"Zheng","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"212","DOI":"10.14245\/ns.2142942.471","article-title":"Comparative analysis of 3 types of minimally invasive posterior cervical foraminotomy for foraminal stenosis, uniportal-, biportal endoscopy, and microsurgery: Radiologic and midterm clinical outcomes","volume":"19","author":"Kim","year":"2022","journal-title":"Neurospine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2670","DOI":"10.1007\/s00586-023-07623-6","article-title":"Learning curve for endoscopic posterior cervical foraminotomy","volume":"32","author":"Perfetti","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.wneu.2017.07.085","article-title":"Clinical observation of posterior percutaneous full-endoscopic cervical foraminotomy as a treatment for osseous foraminal stenosis","volume":"106","author":"Ye","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2369","DOI":"10.1007\/s00701-017-3360-4","article-title":"Clinical and radiological results of posterior cervical foraminotomy at two or three levels: A 3-year follow-up","volume":"159","author":"Lee","year":"2017","journal-title":"Acta Neurochir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jocn.2019.06.012","article-title":"Quantitative radiographic analysis of foraminal re-stenosis after posterior cervical foraminotomy with laminoplasty","volume":"67","author":"Mizouchi","year":"2019","journal-title":"J. Clin. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"20120515","DOI":"10.1259\/bjr.20120515","article-title":"A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images","volume":"86","author":"Park","year":"2013","journal-title":"Br. J. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Lee, J., Lee, J.Y., Kang, K.N., Jang, J.N., Park, S., and Kim, Y.U. (2025). Determination of the most suitable cut-off point of the cervical foraminal cross-sectional area at the C5\/6 level to predict cervical foraminal bony stenosis. Tomography, 11.","DOI":"10.3390\/tomography11060067"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jocn.2019.10.009","article-title":"Quantitative evaluation for cervical foraminal bony stenosis based on angled sagittal slices along a nerve root on computed tomography","volume":"71","author":"Ozaki","year":"2019","journal-title":"J. Clin. Neurosci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1177\/0284185114537929","article-title":"Clinical correlation of a new and practical magnetic resonance grading system for cervical foraminal stenosis assessment","volume":"56","author":"Park","year":"2015","journal-title":"Acta Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1097\/RCT.0000000000000628","article-title":"Interreader reliability and clinical validity of a magnetic resonance imaging grading system for cervical foraminal stenosis","volume":"41","author":"Lee","year":"2017","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E267","DOI":"10.1097\/BRS.0000000000001785","article-title":"Feasibility of posterior cervical foraminotomy in cervical foraminal stenosis: Prediction of surgical outcomes by the foraminal shape on preoperative computed tomography","volume":"42","author":"Gu","year":"2017","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.3348\/kjr.2015.16.6.1294","article-title":"A new MRI grading system for cervical foraminal stenosis based on axial T2-weighted images","volume":"16","author":"Kim","year":"2015","journal-title":"Korean J. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"55","DOI":"10.2214\/AJR.09.2988","article-title":"Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: A prospective study","volume":"194","author":"Rydberg","year":"2010","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1177\/2192568217699190","article-title":"Assessing foraminal stenosis in the cervical spine: A comparison of three-dimensional computed tomographic surface reconstruction to two-dimensional modalities","volume":"7","author":"Schell","year":"2017","journal-title":"Glob. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"20150971","DOI":"10.1259\/bjr.20150971","article-title":"Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations","volume":"89","author":"Lee","year":"2016","journal-title":"Br. J. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"Farrar","year":"2001","journal-title":"Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1186\/1745-6215-15-437","article-title":"Comparison of posterior foraminotomy and anterior foraminotomy with fusion for treating spondylotic foraminal stenosis of the cervical spine: Study protocol for a randomized controlled trial (ForaC)","volume":"15","author":"Tschugg","year":"2014","journal-title":"Trials"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"439","DOI":"10.4055\/cios.2018.10.4.439","article-title":"Clinical and radiological outcomes of foraminal decompression using unilateral biportal endoscopic spine surgery for lumbar foraminal stenosis","volume":"10","author":"Kim","year":"2018","journal-title":"Clin. Orthop. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4129\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:17:59Z","timestamp":1779887879000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114129"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114129","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}