Percutaneous posterior full-endoscopic cervical foraminotomy and discectomy (PECFD) for ASD after anterior cervical decompression and fusion

The purpose of this study was to evaluate the clinical effect of percutaneous posterior full-endoscopic cervical foraminotomy and discectomy (PECFD) for treating degenerative diseases of adjacent cervical segments in patients who have undergone anterior cervical decompression and fusion(ACDF). Method: A retrospective observational study was performed between July 2021 and November 2023 on all patients treated with PECFD for adjacent segment disease (ASD) after ACDF. Clinical outcomes were assessed using a visual simulation scale, modified MacNab criteria, and radiological results. Results: Twelve patients (4 women, 8 men) were enrolled in the study. All patients had achieved good clinical results with PECFD. Post-surgical MRI results showed that all patients achieved complete clearance of the nucleus pulposus and significant improvement in both the angle of cervical lordosis and the height of the intervertebral space. The postoperative Japanese Orthopedic Association (JOA) scores had significantly improved (preoperative vs postoperative day 1, P = 0.01), neck disability index (NDI) score had significantly decreased (preoperative to postoperative day 1, P < 0.001), and the visual analogue scale (VAS) scores for neck pain and arm pain had significantly decreased (P < 0.05) (P = 0.01, P = 0.02, respectively) in all patients. One patient had recurrent ASD. Conclusion: PECFD may be considered as an effective and safe option for the treatment of degenerative diseases at adjacent cervical segments. The advantage of this approach is that it not only provides an effective and safe way to treat cervical ASD, but also minimizes risk of iatrogenic injury.