Complications of Full-Endoscopic Versus Microendoscopic Foraminotomy for Cervical Radiculopathy: A Systematic Review and Meta-Analysis

Abstract

Minimally invasive surgery of posterior cervical foraminotomy (PCF) for symptomatic radiculopathy has gained popularity in the last decade. It remains to be determined whether the 2 dominant operation techniques, full-endoscopic (FE) or microendoscopic (MI), are associated with fewer complications. An electronic retrieval from PubMed, Embase, and Web of Science was performed to identify comparative or single-arm studies concerning FE-PCF and MI-PCF. The pooled incidence of complications was calculated. A total of 26 studies with 2028 patients (FE, 402; MI, 1626) were identified. The overall complication rate was 5.8% for FE-PCF and 3.5% for MI-PCF, with no significant difference (P= 0.115). The pooled complication rate for single-level radiculopathy showed no statistical difference (FE, 4.5%; MI, 3.5%; P= 0.471), either. However, constituent of complications showed apparent disparity, with transient root palsy in FE-PCF (15/19, 78.9%) and dural tear (20/47, 42.6%) in MI-PCF being the most commonly reported. As for the subgroup analysis, both incidence of dural tear (FE, 1.5%; MI, 1.8%; P= 0.672) and superficial wound infection (FE, 2.2%; MI, 1.0%; P= 0.109) showed no statistical difference. Nevertheless, transient root palsy occurred at a higher incidence in the FE group than in the MI group (FE, 4.5%; MI, 1.5%; P= 0.002). Both FE-PCF and MI-PCF can offer relatively safe treatment for cervical radiculopathy. There is no significant difference in overall complication rate between the 2 techniques. Dural tear is the most commonly reported complication of MI-PCF, whereas transient root palsy deserves to be noticed for surgeons performing FE-PCF.