Uniportal Endoscopic Cervical Decompression For Myelopathic Spinal Stenosis

Summary

This article presents an endoscopic cervical decompression technique enabling precise, minimally invasive treatment of myelopathic spinal stenosis with effective neural decompression and reduced tissue damage.

Abstract

This article demonstrates the step-by-step surgical technique of endoscopic cervical decompression for myelopathic cervical spinal stenosis. The procedure allows precise neural decompression under continuous endoscopic visualization while minimizing muscle disruption and aiming to preserve posterior stabilizing structures. The key steps include portal docking, controlled drilling of the osseous structures, and removal of the ligamentum flavum to achieve sufficient spinal cord decompression while avoiding neural injury. Despite its minimally invasive advantages, endoscopic cervical decompression can be technically challenging, particularly for surgeons in the early learning phase, due to the narrow working corridor and close proximity to critical neural elements. Therefore, this video article provides detailed visual guidance and explanations of common technical difficulties, anatomical considerations, and practical strategies to overcome these challenges. By highlighting both procedural steps and potential pitfalls, this protocol demonstrates the feasibility of endoscopic cervical decompression and presents representative institutional outcomes. It aims to facilitate safer and more effective adoption of this minimally invasive treatment option for cervical myelopathy in appropriately selected patients.

Introduction

Approximately 5–20% of patients with cervical spinal stenosis eventually require surgical intervention due to progressive myelopathic symptoms^1,2. Conventional wide posterior decompression through open laminectomy provides sufficient neural decompression; however, it is associated with extensive injury to the posterior musculature and supporting soft tissues³. Such tissue disruption has been reported to contribute to postoperative cervical kyphotic deformity and segmental instability. To mitigate these deformities, posterior instrumentation with screw fixation has been employed in....

Protocol

The procedure described in this article was approved by the Institutional Review Board (IRB No. HRS-IRB 2025-001), and written informed consent was obtained from all patients for participation, video recording, and data collection.

1. Experimental preoperative preparation

1. Patient selection
   NOTE: The primary indication for this procedure is multilevel degenerative cervical myelopathy with predominantly posterior compressive pathology.
   1. Select patients presenting with clinical signs and symptoms of cervical myelopathy, including gait disturbance, hand clumsiness, or upper motor neuron signs.
   ....

Results

Between August 2023 and August 2024, 24 patients underwent uniportal endoscopic cervical decompression at our institution. All patients included in the representative series were consecutive cases treated during the study period. Outcome analysis was performed for patients who completed the predefined 1 year follow-up duration, and no patients were excluded based on clinical outcomes. A total of 15 patients completed >12 months of follow-up (mean 15.2 ± 2.5 months, range 12.0–18.1 months). Around 6 patients had >1 .......

Discussion

Endoscopic posterior cervical decompression is often perceived as one of the most challenging endoscopic spine procedures, requiring a steep learning curve and advanced technical proficiency⁸. These challenges frequently result in incomplete decompression or increased complication risk during the early adoption phase¹⁰. The present protocol aims to address these difficulties by highlighting critical steps and practical strategies for safe and effective decompression. These .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
10K Arthroscope tube set	Conmed	10k100	Irrigation system console
10K Irrigation console	Conmed	10k	Irrigation system console
1-Coarse Diamond Bur SPL (4.5)	Nakanishi	PDS-1CD330-35	High-speed drill
32-inch LCD monitor	Karl Storz	EX3220-3D	Monitor
Biopsy Forceps, Blakesley	JOIMAX	BFS323061	WL 320 mm / OD 3.5 mm / JL 6.0 mm
Biopsy Forceps, Spoon	JOIMAX	THF322541	WL 320 mm / OD 2.5 mm / JL 4.0 mm
Biopsy Forceps, Spoon, angled	JOIMAX	THF322041	WL 320 mm / OD 2.0 mm / JL 4.0 mm / 45°
C-arm fluoroscopy	GEMSS Healthcare	KMC-650
Chloraprep(2% CHG, 70% IPA)	GEMSS Healthcare		Skin preparation material, 26 mL
Closed-suction drain	Moohan co,	M-VAC	100 mL
Delphi plus	CNS Medical	DP410-90-280	Radiofrequency probe
Endo-Kerrison-Pistol Handle	JOIMAX	EKH550000	OD 5.5 mm
Endo-Kerrison-Shaft	JOIMAX	EKS24551540	WL 240 mm / OD 5.5 mm / F 1.5 mm / 40°
Endo-Kerrison-Shaft	JOIMAX	EKS24553040	WL 240 mm / OD 5.5 mm / F 3.0 mm / 40°
Floseal Hemostatic Matrix	Baxter	5 mL Kit	Hemostatic agent
Grasper Forceps	JOIMAX	THG323555	WL 320 mm / OD 3.5 mm / JL 5.5 mm
Guiding Rod, conical	JOIMAX	GRD226315	L 225 mm / OD 6.3 mm
Guiding Tube, conical, red	JOIMAX	GTC177010	L 165 mm / ID 7 mm / OD 10 mm
Guiding Tube, conical, violet	JOIMAX	GTC151510	L 175 mm / ID 10 mm / OD 15 mm
Image 1S Video System	Karl Storz	N/A	Console and camera system
Laminoscope	JOIMAX	LS1006125O	WL 125 mm / OD 10.0 mm / 15° / WChD 6.0 mm / 2x IC 2.0 mm
Nerve Hook	JOIMAX	TNH322533	L 320 mm / OD 2.5 mm / JL 3.3 mm
Primado2 Drill System	Nakanishi	P200-CU-100	High-speed drill
Primado2 Foot Controler	Nakanishi	FC-73	High-speed drill
Primado2 Slim motor handpiece	Nakanishi	P200-SMH-HS	High-speed drill
Safety straps/Padding-related setup	JU medics		Face sponge, Leg straps
Semi-Flexible Grasper Forceps, curved, up-biting	JOIMAX	TFG322522U	WL 320 mm / OD 2.5 mm / Helix
Skin Adhesive Exofin	Chemence Medical		1 mL
Super Slim attachment 200	Nakanishi	P200-RA330	High-speed drill
Surgi-Max Air	Elliquence	IEC4-SP	Radiofrequency probe
Trigger-Flex	Elliquence	DTF-40	Radiofrequency probe
Vicryl	Ethicon		Absorbable sutures, size 3-0
Wilson frame	Mizuho OSI		Radiolucent