Uniportal Endoscopic Versus Biportal Endoscopic Versus Microscopic/Tubular Posterior Cervical Foraminotomy: A Structured Debate and International Practice Patterns
Abstract
This structured debate integrates a narrative evidence synthesis with an international practice-pattern survey comparing uniportal endoscopic cervical foraminotomy (PECF), unilateral biportal endoscopic cervical foraminotomy (UBE-CF), and microscopic/tubular posterior cervical foraminotomy. The literature search covered January 1990 to July 5, 2026. Comparative evidence was predominantly retrospective, single-center, and heterogeneous. Background and expertise data were available for 75 respondents, including 74 with endoscopic expertise, and 73 completed all 4 clinical scenarios. Uniportal-only respondents predominantly selected PECF, whereas biportal-only respondents favored UBE-CF. Treatment choices differed across the predefined clinical scenarios, with anterior cervical discectomy and fusion (ACDF) selected by 19 of 73 (26.0%), 35 of 73 (47.9%), 19 of 73 (26.0%), and 49 of 73 respondents (67.1%) in cases 1–4, respectively. These scenarios changed several clinical features simultaneously and do not establish the independent influence of any single feature. Available comparative studies have not established durable superiority of one posterior technique over another. ACDF was the most frequently selected single procedure in the scenario combining retrolisthesis, asymptomatic central stenosis, and motor weakness (case 2) and in the revision scenario (case 4). Platform selection should reflect surgeon expertise, anatomy, and available resources. Multicenter randomized or expertise-based comparative trials with standardized outcomes and long-term follow-up are needed.
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Authors: Enrico Giordan, Piya Chavalparit, Jean–Yves Fournier, Hussam Essam Jabri, Woo‐Keun Kwon, Chang Kyu Lee, Florian Wanivenhaus, Mazda Farshad, Christian Morgenstern, Meng–Huang Wu, Pius Kim, Ahmed Alqatub, Asrafi Rizki Gatam, Hamdi Öztürk, Rafael Lindi Sugino, Suthipas Pongmanee, Khanathip Jitpakdee, Weerasak Singhatanadgige, Vit Kotheeranurak, Ahmed Ibrahim, Saqib Hasan, Xuexiao Ma, Jae‐Joong Kim
Institutions: Hospital Israelita Albert Einstein, Chiang Mai University, Yonsei University, King Chulalongkorn Memorial Hospital, Affiliated Hospital of Qingdao University, Yonsei University Health System, Catholic University of Korea, Taipei Medical University, Chulalongkorn University, Imperial College Healthcare NHS Trust, AULSS 2 Marca Trevigiana, University of Zurich, Taipei Medical University Hospital, Hospital Quirón Teknon, Izmir University, Riyadh Armed Forces Hospital, Severance Hospital, Universitätsklinik Balgrist, The Catholic University of Korea Seoul St. Mary's Hospital, Chosun University, Navamindradhiraj University, Fatmawati Hospital, Chosun University Hospital, Hôpital de Sion, Vajira Hospital, Korea University Guro Hospital, Queen Savang Vadhana Memorial Hospital