A retrospective comparative analysis of postoperative opioid utilization following uniportal endoscopic versus minimally invasive versus open approaches for posterior cervical foraminotomy

OBJECTIVE Posterior cervical foraminotomy (PCF) for the treatment of radiculopathy can be performed via open, minimally invasive (MIS), or more recently emerging endoscopic approaches. Although proponents of endoscopy cite decreased postoperative pain as an advantage compared with open or MIS approaches, few studies have been performed to evaluate this outcome. METHODS The authors retrospectively identified all patients undergoing PCF at a single institution from January 1, 2015, to June 1, 2024. Patients were stratified by operative approach (open, MIS, or uniportal endoscopic). The primary outcome was opioid consumption at 6 weeks, 3 months, and 6 months postoperatively, as well as cumulative opioid consumption in morphine milligram equivalents (MME) at each time interval. Secondary outcomes included short-term perioperative outcomes such as complications, operative duration, pain relief, and reoperation. RESULTS One hundred thirty-eight patients met inclusion criteria, of whom 37 underwent open, 67 underwent MIS, and 34 underwent uniportal endoscopic procedures. Patients undergoing MIS and endoscopic approaches had lower rates of opioid use at 6 weeks compared with open approaches (relative risk 0.51 and 0.39, respectively). Endoscopic procedures were associated with lower total opioid MME within 6 weeks than both MIS and open procedures (238.4 vs 479.4 vs 753.8), although MIS and endoscopic procedures had similar rates of opioid use at 6 weeks. A subgroup analysis of a propensity score–matched cohort based on preoperative demographic data revealed a similar association between operative approach and total MME, although there were no significant differences between the cohorts in the proportion of patients using opioids at any of the follow-up intervals. CONCLUSIONS In this retrospective analysis, both endoscopic and MIS PCF were associated with lower overall rates and amount of opioid use with similar rates of short-term complications, reoperations, and pain relief as open approaches.