Therapeutic Efficacy of Full-Endoscopic Unilateral Laminotomy with Bilateral Decompression for Degenerative Cervical Myelopathy: A Retrospective Cohort Study

Background: This study aims to evaluate the efficacy and potential advantages of full-endoscopic unilateral laminotomy with bilateral decompression (FE-ULBD) for degenerative cervical myelopathy (DCM) as a minimally invasive posterior decompression technique. Methods: We retrospectively reviewed 123 patients treated between January 2020 and January 2025. Procedures were selected based on predefined clinical/imaging indications and shared decision-making. FE-ULBD was primarily applied to 1– 2-level posterior compression, whereas multilevel disease underwent laminoplasty or laminectomy with internal fixation. Patients were assigned to Group A (FE-ULBD, n=28), Group B (single-door laminoplasty, n=60), and Group C (laminectomy with internal fixation, n=35). Baseline characteristics, perioperative parameters (operative time, blood loss, length of stay), clinical outcomes (mJOA at multiple time points and modified MacNab criteria), and complications were compared among groups. In Group A, intervertebral height, C2–C7 Cobb angle, and dural sac cross-sectional area (DSCA) were evaluated pre- and postoperatively. Outcomes were assessed preoperatively, at 3 months postoperatively, and at final follow-up (mean 8.07 ± 2.24 months). Results: Group A had significantly shorter operative time, reduced blood loss, and a shorter hospital stay compared to Groups B and C (all P 0.05). The excellent/good rate by modified MacNab criteria at final follow-up was 89.3% in Group A, 76.7% in Group B, and 77.1% in Group C (P> 0.05). The overall complication rate was lower in Group A (P< 0.05). In Group A, intervertebral height and C2–C7 Cobb angle showed no significant postoperative change, whereas DSCA increased significantly (P< 0.05). Conclusion: In this retrospective cohort, FE-ULBD was associated with less perioperative morbidity and fewer complications while providing neurological recovery comparable to conventional posterior approaches in selected DCM patients. Keywords: degenerative cervical myelopathy, unilateral laminotomy with bilateral decompression, minimally invasive cervical spine surgery, full-endoscopic spine surgery, radiological outcomes