Comparative Study on Clinical Outcomes of Posterior Endoscopic Cervical Foraminotomy under Local Anesthesia with Conscious Sedation and General Anesthesia

Lim, Jason K.; Raza, Marium; Lim, Do H.; Kim, Samuel; Breton, Jeffrey M.; Zhao, David; Kim, Patrick; Nair, Mani N.; Hofstetter, Christoph P.; Rim, Byeong Cheol

doi:.0..

Journal of Korean Neurosurgical Society > Accepted Articles

Clinical Article

doi: https://doi.org/10.3340/jkns.2024.0229 [Accepted]

Comparative Study on Clinical Outcomes of Posterior Endoscopic Cervical Foraminotomy under Local Anesthesia with Conscious Sedation and General Anesthesia

, Christoph P. Hofstetter³

, Byeong Cheol Rim⁶

¹Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA
²Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
³Department of Neurological Surgery, University of Washington, Seattle, WA, USA
⁴University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
⁵Department of Neurological Surgery, University of South Florida, Tampa, FL, USA
⁶Rim's Neuro Clinic, Cheong, Korea

Correspondence

Jason K. Lim ,Email: jkl97@georgetown.edu

Received: December 17, 2024; Revised: March 20, 2025 Accepted: June 6, 2025. Published online: June 9, 2025.

ABSTRACT

Objective
: Posterior endoscopic cervical foraminotomy (PECF) is a minimally invasive surgical technique for treating cervical radiculopathy. Traditionally, PECF is performed under general anesthesia in the prone position, but concerns over anesthesia-related complications have led to the exploration of local anesthesia in the lateral decubitus position as an alternative. This study aims to compare the clinical outcomes, safety, and efficacy of PECF performed under local anesthesia in the lateral decubitus position versus general anesthesia in the prone position.
Methods
: We conducted a retrospective analysis of 13 patients who underwent PECF under local anesthesia in the lateral decubitus position. The outcomes were compared with data from 357 patients across eight studies who underwent PECF under general anesthesia in the prone position. Outcomes measures included visual analog scale (VAS) pain scores, Oswestry disability Index (ODI), length of stay (LOS), minimally clinically important difference (MCID), and complications.
Results
: Patients in the local anesthesia group demonstrated significant reductions in neck pain (VAS-N: 4.93±1.32 to 1.49±0.52, p<0.001) and arm pain (VAS-A: 8.69±0.75 to 1.85±1.46, p<0.001), achieving a mean pain reduction of 78.8%. These improvements were comparable to the general anesthesia group (VAS-N: 4.80 to 1.28; VAS-A: 6.71 to 1.23). Functional outcomes improved significantly in both groups, with ODI scores improving from 54.76% to 9.82% locally and from 39.92% to 9.62% in the general group. Although length of stay was slightly longer for the local anesthesia group (5.85±3.20 vs. 4.81±2.17 days, p=0.18), post-procedure monitoring time was significantly shorter (3.2 vs. 7.4 hours, p<0.001). The local anesthesia group reported zero complications (0%, 95% CI: 0–22.8%) compared to an 8.68% complication rate (95% CI: 5.8%–11.6%) in the general anesthesia cohort (p=0.612).
Conclusion
: PECF under local anesthesia in the lateral decubitus position provides comparably effective pain relief and functional improvement comparable to general anesthesia, though the difference in complication rates was not statistically significant and requires larger studies for confirmation. This technique may be particularly advantageous for patients at higher risk for anesthesia-related complications. Further research is warranted to validate these findings in larger, prospective studies.

Key Words: Posterior endoscopic cervical foraminotomy (PECF) · Local anesthesia, general anesthesia · Cervical radiculopathy · Minimally invasive surgery · Lateral decubitus position