Posterior Endoscopic Cervical Foraminotomy

Posterior endoscopic cervical foraminotomy (PECF) is a minimally invasive surgical approach designed to decompress cervical nerve roots in patients with unilateral radiculopathy and select cases of myelopathy. Unlike traditional open surgery or anterior cervical discectomy and fusion (ACDF), PECF preserves segmental motion while minimizing soft tissue disruption, blood loss, and recovery time. This chapter provides a detailed overview of the technique, including preoperative planning, patient positioning, endoscopic trajectory, and key anatomical landmarks. A stepwise surgical protocol is described, with emphasis on safe decompression, facet preservation, and avoidance of vertebral artery or neural injury. The chapter also addresses complication management, including strategies to reduce the risk of C5 palsy, incidental durotomy, postoperative hematoma, and recurrent disc herniation. Recent evidence supports PECF as a cost-effective and motion-preserving alternative to ACDF in appropriately selected patients. This chapter aims to guide spine surgeons through the practical and technical nuances of PECF, supported by current literature and operative experience.