Modified K-Hole Percutaneous Endoscopic
Surgery for Cervical Foraminal Stenosis: Partial
Pediculectomy Approach
Authors: Deng Zhong-Liang 
Published: February 2021

Background: Percutaneous endoscopic cervical discectomy has evolved as an efficient, minimally
invasive spine surgery for radiculopathy caused by soft and/or osseous foraminal stenosis. Although
interlaminar access can be used to resect lateral herniated lesions or osteophytes located in the
foramina, with limited operative space, nerve retraction may be unavoidable. This procedure may
injure the nerve root and cause postoperative arm pain, numbness, and muscle weakness, especially
when the herniation is located in the ventral nerve root or when there is a massive osteophyte in
the foramina. However, posterior partial cervical pediculectomy under endoscopy provides a new
approach to effectively reduce or even avoid nerve retraction and reduce the potential risk of nerve
injury.
Objectives: This report presents a partial pediculectomy approach and compares the clinical
outcomes of different surgical methods, including posterior percutaneous endoscopic cervical
discectomy (P-PECD) and P-PECD combined with partial pediculectomy
Study Design: This study used a retrospective comparative study design.
Setting: This study took place at the Second Affiliated Hospital of Chongqing Medical University.
Methods: From February 2015 to March 2017, 84 patients with single-level and unilateral soft
and/or osseous cervical foraminal stenosis were recruited. Patients were treated with P-PECD (40
patients) and P-PECD combined with partial pediculectomy (44 patients). Postoperative clinical
outcomes were assessed using the modified MacNab grading criteria and the Visual Analog Scale
(VAS) at different times after surgery. The surgery duration, dosage of postoperative analgesic
medication, duration of hospital stay, and postoperative complications were recorded.
Results: The mean duration of the conventional P-PECD surgery was 74.48 ± 7.08 minutes, which
was significantly longer (P = 0.002) than that observed for the P-PECD with partial pediculectomy
(66.00 ± 9.62 minutes). The analgesic dosage in the conventional P-PECD group was significantly
higher than that in the partial pediculectomy group (9.14 ± 3.07 units vs. 5.71 ± 3.41 units; P =
0.001). The hospital stay in the conventional P-PECD group was significantly longer than that in the
partial pediculectomy group (3.86 ± 0.85 days vs. 3.24 ± 0.83 days; P = 0.022). The VAS scores at 1
day, 3 days, and 7 days after surgery in the conventional P-PECD group were significantly higher than
those in the partial pediculectomy group (all P < 0.001). The modified MacNab grading criteria showed
no significant difference at each follow-up (P = 1). The incidence of complications in the P-PECD
with partial pediculectomy group (2/44, 4.55%) was significantly lower than that in the conventional
P-PECD group (4/40, 10.0%), including complications of increased pain, increased numbness, and
worsening of muscle weakness.
Limitations: This study is limited by being a retrospective study, and by having a small sample size
and a short follow-up period.
Conclusions: As an alternative to the P-PECD surgical technique, P-PECD with partial pediculectomy
effectively reduced the postoperative complications and may be preferable when considering the
surgery duration, postoperative hospital stay, analgesic dosage, and postoperative VAS score.
Key words: Cervical disc herniation, foraminal stenosis, percutaneous endoscopic cervical
discectomy, PECD, P-PECD, partial pediculectomy