Cervical Endoscopic ULBD (CE-ULBD)

The spinal cord runs through the canal in the neck. When that canal narrows centrally — from thickened ligament, bone spurs, bulging discs, or an ossified ligament — the cord itself can be compressed. This can cause cervical myelopathy: a gradual loss of fine hand function, clumsiness, changes in walking and balance, and sometimes arm and leg symptoms. Myelopathy is a serious condition because pressure on the cord, if left, can cause lasting damage, so relieving it in good time is important. Traditionally this has meant a larger posterior operation — a laminectomy, often with a fusion — or an operation from the front.

The cervical endoscopic ULBD applies the same elegant principle used in the lower back: enter through a keyhole on one side only and, by angling the endoscope across underneath the bony roof of the canal — "over the top" of the cord — decompress both sides through that single small opening. The thickened ligament and the overgrown bone crowding the cord are removed under continuous saline irrigation and magnified vision, first on the near side and then, by tilting across the midline, on the far side. Because only one side is opened and the muscles and much of the bony architecture on the far side are preserved, the neck's stability and movement are largely maintained — often avoiding the need for the fusion that a traditional wide laminectomy may require. The aim is a full, circumferential relief of the cord through a corridor a few millimetres wide.

I want to be especially clear and measured here, because decompressing the spinal cord endoscopically is among the most demanding and highest-stakes work in the field, and it must be approached with great caution and the right patient selection. Working over the top of a compressed cord, with a fine drill, leaves no margin for error; the decompression must be complete, the cord must never be pressured, and bleeding must be controlled meticulously. This is not an operation for every case of cervical stenosis — the extent and nature of the narrowing, the presence of instability or deformity, and the state of the cord all determine whether an endoscopic decompression is appropriate or whether a traditional laminectomy, a fusion, or an anterior operation is the safer and better choice. Making that judgement honestly, and reserving the endoscopic approach for the cases genuinely suited to it, is as much a part of the expertise as the technique itself. It is exactly the kind of frontier surgery I have subspecialised in, applied selectively and carefully.

The evidence for endoscopic posterior cervical decompression is emerging and encouraging, though it is younger than the evidence for the lumbar spine, which is why careful selection matters. Series describe full-endoscopic and biportal endoscopic posterior cervical decompression — including unilateral approaches for bilateral decompression and central decompression for stenosis, myelopathy and ossified ligament — reporting good neurological improvement with the tissue-sparing benefits of a keyhole approach and, in suitable cases, preservation of motion by avoiding a fusion. Comparative and propensity-matched studies against anterior fusion for single-level stenosis report comparable outcomes. As with all newer techniques, the literature rightly emphasises meticulous technique and appropriate case selection, which is precisely the standard I hold myself to.

Where CE-ULBD is appropriate, the tissue-sparing, keyhole nature of the operation means recovery is often quicker and more comfortable than a traditional open decompression, with the neck's movement preserved. Improvement in myelopathic symptoms — hand function, balance — can be gradual, and the aim of surgery is often to halt progression and allow recovery over time rather than to reverse everything at once. Recovery is guided closely by the team, and the neck and neurological function are followed up carefully over the longer term. Because this is advanced surgery, the plan is always individualised after a thorough assessment.

• —Ye ZY, et al. Full-endoscopic laminotomy decompression versus ACDF for single-segment cervical stenosis: propensity-matched study. (PMID 38581052)
• —Zhang C, et al. Posterior percutaneous full-endoscopic cervical laminectomy for cervical stenosis with myelopathy. (PMID 30648610)
• —Deng Y, et al. Unilateral biportal endoscopic laminectomy for cervical stenosis: technical note and preliminary results. (PMID 36837505 / PMC9965142)
• —Kang MS, et al. Unilateral biportal endoscopic laminectomy with lateral mass fixation for cervical stenosis. (PMID 35486201)
• —Zhu C, et al. Cervical posterior decompression using unilateral biportal endoscopic technique: case series. (PMID 39547679)
• —Park DK, et al. Endoscopic posterior cervical decompression for ossified posterior longitudinal ligament: technical note. (PMID 37230800)
• —Chien KT, et al. Cervical endoscopic unilateral laminoforaminotomy for bilateral decompression in myeloradiculopathy: technical note and results. (PMID 38610672 / PMC11012691)