Abstract:
Background: Posterior cervical laminoforaminotomy is an established motion-preserving procedure for unilateral cervical radiculopathy. However, adequate distal foraminal decompression may require substantial facet resection, potentially compromising segmental stability. The inclinatory approach permits oblique facet undercutting while preserving the posterior facet complex. We evaluated the clinical outcomes, quantitative facet preservation, and early radiographic stability following biportal endoscopic posterior cervical inclinatory laminoforaminotomy (BEPCLIF).
Methods: A prospective observational study was conducted at Nizam's Institute of Medical Sciences, Hyderabad, between November 2025 and April 2026. Eighteen consecutive patients involving 20 cervical levels with unilateral cervical radiculopathy secondary to foraminal disc herniation or bony foraminal stenosis underwent BEPCLIF. Clinical outcome was assessed using arm pain Visual Analogue Scale (VAS). Preoperative and postoperative CT-based facet volumes were measured using three-dimensional volumetric analysis. Dynamic radiographs were used to evaluate disc height, segmental angle, cervical alignment, and segmental range of motion (ROM). Radiographic instability was assessed using modified White and Panjabi criteria.
Results: The mean age was 42.8 ± 9.0 years, with a mean follow-up of 5.4 ± 1.4 months. Disc herniation accounted for 55.6% of cases and bony foraminal stenosis for 44.4%. Mean arm pain VAS improved significantly from 8.78 ± 0.73 preoperatively to 2.22 ± 0.65 at final follow-up (p < 0.001). Mean facet volume decreased from 0.752 ± 0.150 cm³ to 0.526 ± 0.171 cm³, corresponding to a mean facet resection of 30.8% ± 16.5%. Segmental ROM was maintained (1.31° ± 0.76° preoperatively versus 1.61° ± 1.25° postoperatively; p = 0.295), while overall cervical alignment remained unchanged (p = 0.575). No patient demonstrated radiographic segmental instability or required reoperation for recurrent radiculopathy or instability during follow-up. Three patients experienced complications: one transient dural tear involving a conjoint nerve root, one transient C6 paresthesia, and one intraoperative conversion to an anterior approach.
Conclusions: BEPCLIF achieved significant improvement in radicular pain while allowing foraminal decompression with relatively limited facet resection and preservation of early segmental motion. Three-dimensional CT volumetry provides an objective method for quantifying facet preservation. These preliminary findings support the potential of an inclinatory biportal approach as a facet-preserving, motion-sparing technique for appropriately selected patients with cervical radiculopathy. Longer follow-up and comparative studies are required to determine the long-term implications of facet preservation for segmental stability and degenerative change.
Biography:
Dr. Yerragunta Thirumal is an Additional Professor of Neurosurgery at Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India. He completed his M.Ch. in Neurosurgery at NIMS and has extensive experience in complex cranial and spinal surgery. His clinical and academic interests include minimally invasive spine surgery, biportal endoscopic surgery, skull-base surgery, cerebral revascularization, neuro-oncology, and neurotrauma. He has performed more than 6,000 brain and spine procedures and has trained neurosurgical residents at NIMS. His research focuses on developing minimally invasive and motion-preserving techniques in neurosurgery.
© 2026 Mathews International LLC. All rights reserved.
