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involved in this field can start with endoscopic lumbar discectomy of Cervical Radiculopathy. Int J Spine Surg 2016;10:1.
in a transforaminal approach, which is easier for beginners. [5] Gao Y, Liu M, Li T, Huang F, Tang T, Xiang Z. A Meta-
There were some limitations in this study. First, the sample size Analysis Comparing the Results of Cervical Disc
in this study was limited, which may increase bias. Second, the Arthroplasty with Anterior Cervical Discectomy and
proficiency of surgery influences the clinical outcomes. Third, this Fusion (acdf) for the Treatment of Symptomatic Cervical
study was a retrospective cohort study. A randomized controlled Disc Disease. J Bone Joint Surg Am 2013;95:555-61.
trial (RCT) would be better to illuminate the clinical outcome [6] Chung SW, Kim HJ, Lee SH, Lee SY, Kang MS, Shin YH,
difference between the two different posterior MIS techniques. et al. Posterior Cervical Foraminotomy for Cervical
However, to our knowledge, this is the first comparative Radiculopathy: Should Cervical Alignment be Considered?
study between these different keyhole surgeries despite the J Spine Surg 2019;5:541-8.
abovementioned limitations. In future, a multicenter RCT study
with a larger number of cases will be required to clarify the [7] Song KJ, Choi BY. Current Concepts of Anterior Cervical
effectiveness and safety of both techniques. Discectomy and Fusion: A Review of Literature. Asian
With similar surgical complication rates, both endoscopic Spine J 2014;8:531-9.
keyhole and microscopic keyhole techniques are effective in [8] Shin JJ. Comparison of Adjacent Segment Degeneration,
treating cervical radiculopathy resulting from posterolateral disc Cervical Alignment, and Clinical Outcomes After One-
herniation. However, compared with the microscopic keyhole and Multilevel Anterior Cervical Discectomy and Fusion.
technique, the EKT brings about a higher revision surgery rate Neurospine 2019;16:589-600.
with a shorter interval time from index surgery to revisional [9] Hilton DL Jr. Minimally Invasive Tubular Access for
surgery. Posterior Cervical Foraminotomy with Three-Dimensional
Acknowledgments Microscopic Visualization and Localization with Anterior/
Posterior Imaging. Spine J 2007;7:154-8.
We appreciate the editors and reviewers for the helpful [10] Kiely PD, Quinn JC, Du JY, Lebl DR. Posterior Surgical
comments on this manuscript. Treatment of Cervical Spondylotic Myelopathy: Review
Article. HSS J 2015;11:36-42.
Funding
[11] Saadeh YS, Sabbagh MA, Smith BW, Joseph JR,
This study was supported by Double-thousand Plan Program Buckingham MJ. Technique for Open Posterior Cervical
of Jiangxi Province (JXSQ2023201023) and Clinical Cultivation Foraminotomy: 2-Dimensional Operative Video. Oper
Project of the First Affiliated Hospital of Nanchang University Neurosurg (Hagerstown) 2020;18:E120.
(YFYLCYJPY202202). [12] Ward SR, Kim CW, Eng CM, Gottschalk LJ 4 , Tomiya A,
th
Conflicts of Interest Garfin SR, et al. Architectural Analysis and Intraoperative
Measurements Demonstrate the Unique Design of the
The authors have declared no conflicts of interest. Multifidus Muscle for Lumbar Spine Stability. J Bone Joint
Surg Am 2009;91:176-85.
Ethics Approval and Consent to Participate
[13] Aldrich F. Posterolateral Microdisectomy for Cervical
This study has been approved by The First Affiliated Hospital Monoradiculopathy Caused by Posterolateral Soft Cervical
of Nanchang University. Disc Sequestration. J Neurosurg 1990;72:370-7.
Consent for Publication [14] Kunert P, Prokopienko M, Marchel A. Posterior
Microlaminoforaminotomy for Cervical Disc Herniation.
All patients gave their oral and written consent. Neurol Neurochir Pol 2010;44:375-84.
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DOI: http://dx.doi.org/10.18053/jctres.09.202304.23-00023