{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:09:59Z","timestamp":1790244599444,"version":"4.1.0"},"reference-count":27,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objectives: This study presents a novel anchored drill-assisted localization technique for percutaneous endoscopic cervical keyhole surgery in single-level cervical spondylotic radiculopathy (CSR). This technical report describes its feasibility, preliminary efficacy, and safety. Methods: We retrospectively analyzed 40 consecutive patients with single-level CSR treated with this technique (July 2023\u2013August 2025). Operative time, blood loss, hospital stay, and complications were recorded. Decompression safety was evaluated on postoperative computed tomography (CT) by measuring the distance between the bone resection margin and the intervertebral foramen. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain, the Japanese Orthopaedic Association (JOA) score, the Neck Disability Index (NDI), and modified MacNab criteria. Results: No major complications occurred. Minor complications included transient axial neck pain in 3 patients (7.5%) and persistent axial neck pain in 1 patient (2.5%). After a median follow-up of 15.2 (12.2\u201326.1) months, all clinical scores improved significantly (all p &lt; 0.001). The mean JOA score increased from 13.8 \u00b1 2.0 to 16.5 \u00b1 1.1, and mean NDI decreased from 45.6 \u00b1 8.9% to 9.8 \u00b1 8.2%. Neck and arm VAS decreased from 5.4 \u00b1 1.8 and 5.4 \u00b1 2.1 to 0.7 \u00b1 1.2 and 0.8 \u00b1 1.0, respectively. The excellent\/good rate by modified MacNab criteria was 97.5% (39\/40). Conclusions: The anchored drill-assisted technique may enhance spatial orientation, potentially reduce fluoroscopy use, and establishes a clear safety boundary. This preliminary report demonstrates favorable safety and efficacy in treating single-level CSR. Prospective comparative studies are warranted.<\/jats:p>","DOI":"10.3390\/jcm15197423","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:07:54Z","timestamp":1790240874000},"page":"7423","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anchored Drill-Assisted Localization for Percutaneous Endoscopic Cervical Keyhole Surgery in the Treatment of Cervical Spondylotic Radiculopathy: A Technical Report and Preliminary Efficacy Evaluation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6667-2163","authenticated-orcid":false,"given":"Zhuangzhuang","family":"Tan","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510261, China"},{"name":"The Second Clinical School, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6392-4671","authenticated-orcid":false,"given":"Bin","family":"Xie","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510261, China"},{"name":"The Second Clinical School, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajun","family":"Cheng","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510261, China"},{"name":"The Second Clinical School, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutao","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510261, China"},{"name":"The Second Clinical School, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1698-5505","authenticated-orcid":false,"given":"Hui","family":"Ren","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510261, China"},{"name":"The Second Clinical School, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weibo","family":"Yu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510261, China"},{"name":"The Second Clinical School, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8009-0282","authenticated-orcid":false,"given":"Xiaobing","family":"Jiang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510261, China"},{"name":"The Second Clinical School, Guangzhou Medical University, Guangzhou 510180, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E251","DOI":"10.1097\/BSD.0000000000000284","article-title":"Cervical radiculopathy: Epidemiology, etiology, diagnosis, and treatment","volume":"28","author":"Woods","year":"2015","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1016\/j.spinee.2014.02.032","article-title":"The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: A systematic review of the literature","volume":"14","author":"Wong","year":"2014","journal-title":"Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"408","DOI":"10.14245\/ns.1938250.125","article-title":"Anterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations","volume":"16","author":"Deora","year":"2019","journal-title":"Neurospine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.3171\/2016.2.FOCUS1626","article-title":"Clinical adjacent-segment pathology after central corpectomy for cervical spondylotic myelopathy: Incidence and risk factors","volume":"40","author":"Vedantam","year":"2016","journal-title":"Neurosurg. Focus"},{"key":"ref_5","first-page":"107","article-title":"Comparative analysis of the biomechanics of the adjacent segments after minimally invasive cervical surgeries versus anterior cervical discectomy and fusion: A finite element study","volume":"23","author":"Chen","year":"2020","journal-title":"J. Orthop. Transl."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/BSD.0b013e31820ef328","article-title":"Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: Outcome, complications, and technique","volume":"24","author":"Tzaan","year":"2011","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"582","DOI":"10.4184\/asj.2016.10.3.582","article-title":"Adjacent Segment Pathology after Anterior Cervical Fusion","volume":"10","author":"Chung","year":"2016","journal-title":"Asian Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.spinee.2023.12.010","article-title":"Comparing outcomes between anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) in the treatment of cervical radiculopathy","volume":"24","author":"Changoor","year":"2024","journal-title":"Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3005","DOI":"10.1007\/s00586-015-4198-1","article-title":"Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation","volume":"24","author":"Kim","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_10","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_11","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/s13018-025-05617-2","article-title":"Comparison of clinical efficacy of posterior percutaneous endoscopic cervical discectomy versus unilateral biportal endoscopy key-hole techniques for cervical spondylotic radiculopathy: A retrospective study with 2 years","volume":"20","author":"Zhang","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1007\/s11596-020-2299-5","article-title":"Keyhole Foraminotomy via a Percutaneous Posterior Full-endoscopic Approach for Cervical Radiculopathy: An Advanced Procedure and Clinical Study","volume":"40","author":"Luo","year":"2020","journal-title":"Curr. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"171","DOI":"10.22603\/ssrr.2023-0213","article-title":"Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis","volume":"8","author":"Morimoto","year":"2023","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e34653","DOI":"10.1097\/MD.0000000000034653","article-title":"Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review","volume":"102","author":"Sakellariou","year":"2023","journal-title":"Medicine"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kim, H.S., Wu, P.H., Chin, B.Z.J., and Jang, I.T. (2023). Clinical and Radiological Outcomes of a Comparative Study of Anterior Cervical Decompression and Fusion with Partial Pediculotomy, Partial Vertebrotomy (PPPV) Posterior Endoscopic Cervical Decompression (PECD) for Cervical Foraminal Pathology. Medicina, 59.","DOI":"10.3390\/medicina59071222"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.wneu.2018.12.180","article-title":"Posterior Percutaneous Full-Endoscopic Cervical Laminectomy and Decompression for Cervical Stenosis with Myelopathy: A Technical Note","volume":"124","author":"Lin","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105948","DOI":"10.1016\/j.clineuro.2020.105948","article-title":"Posterior full-endoscopic cervical discectomy in cervical radiculopathy: A prospective cohort study","volume":"195","author":"Liang","year":"2020","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_18","first-page":"625","article-title":"Posterior cervical sequestrectomy via keyhole foraminotomy: A case series comparing microdiscectomy with endoscope assisted discectomy","volume":"32","author":"Dalgic","year":"2021","journal-title":"Turk. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"10290","DOI":"10.1038\/s41598-020-67381-z","article-title":"Trans-interlamina percutaneous endoscopic cervical discectomy for symptomatic cervical spondylotic radiculopathy using the new Delta system","volume":"10","author":"Haijun","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e20216","DOI":"10.1097\/MD.0000000000020216","article-title":"Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy: Short-term outcomes of 24 cases","volume":"99","author":"Yao","year":"2020","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3093","DOI":"10.2147\/JPR.S451943","article-title":"Evaluation of the Effectiveness of Cervical One-Hole Split Endoscopic Keyhole Surgery for Cervical Radiculopathy","volume":"17","author":"Feng","year":"2024","journal-title":"J. Pain Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1097\/BRS.0b013e31817e69b7","article-title":"Cervical spine imaging using standard C-arm fluoroscopy: Patient and surgeon exposure to ionizing radiation","volume":"33","author":"Giordano","year":"2008","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1007\/s00586-018-5653-6","article-title":"Radiation exposure to the surgeon during minimally invasive spine procedures is directly estimated by patient dose","volume":"27","author":"Farber","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/BRS.0b013e318275ca58","article-title":"Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: A prospective study","volume":"38","author":"Ahn","year":"2013","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/j.spinee.2009.08.002","article-title":"Digital versus plain film imaging in the operating room: Cost and safety considerations","volume":"9","author":"Resnick","year":"2009","journal-title":"Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"22","DOI":"10.2106\/00004623-199274010-00004","article-title":"Cervical stability after foraminotomy. A biomechanical in vitro analysis","volume":"74","author":"Zdeblick","year":"1992","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1097\/00007632-199310001-00013","article-title":"Cervical stability after sequential capsule resection","volume":"18","author":"Zdeblick","year":"1993","journal-title":"Spine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7423\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:37:27Z","timestamp":1790242647000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":27,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197423"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197423","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}