Hanjin Jang, MDEndoscopic Spine Surgery
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Case 05 · Cervical · Decompression

UBE Cervical ULBD for CSM

How do myelopathy, alignment, and compression pattern inform the approach?

Clinical summary · Source: Hanjin Jang, MD academic case collection · Page updated 2026-09-11

Diagnosis

Cervical spondylotic myelopathy associated with multilevel cervical spinal stenosis at C4-C6.

Procedure and level

UBE cervical unilateral laminotomy for bilateral decompression, ULBD, at C4-5 and C5-6 through a left-sided approach. C4-5 and C5-6.

Surgical levels and level count

Treated levels
2 levels
C4-C5 · C5-C6
Decompression
2 levels
C4-C5 · C5-C6
New fusion
None described

Bilateral decompression through one-sided access at two segments counts as two levels, not four.

One level means one treated motion segment, such as L4-L5. Decompression and fusion can overlap; their counts are not added. Counts follow the source description and have not been re-audited against private charts.

Clinical presentation

The patient presented with gait imbalance and subjective lower-extremity weakness. The clinical history suggested progressive myelopathic symptoms rather than isolated radiculopathy. Cervical imaging was reviewed together with the neurologic examination before surgical planning.

Neurologic findings

The clinical record described gait disturbance and lower-extremity weakness symptoms. Upper-extremity motor testing was not clearly focal in the available summary. Sensory findings and long-tract signs are not reported in the available summary.

Prior nonoperative treatment

Not reported in the available educational summary.

Imaging and clinical concordance

Preoperative cervical radiographs and MRI demonstrated multilevel cervical spondylotic stenosis at C4-C6. The MRI findings were reviewed for spinal cord compression and possible cord signal change in the context of cervical spondylotic myelopathy.

Reasoning recorded for the procedure

Endoscopic cervical decompression was considered because the patient had clinical features consistent with cervical myelopathy and imaging findings of multilevel cervical stenosis. The surgical objective was posterior decompression of the cervical spinal canal at the clinically concordant levels while preserving posterior stabilizing structures as appropriate.

Operative considerations

UBE cervical ULBD was performed at C4-5 and C5-6 through a left-sided approach. The operative workflow focused on controlled posterior decompression, identification of the laminar and ligamentous anatomy, protection of the dura and spinal cord, and bilateral decompression through a unilateral endoscopic corridor.

Postoperative course

Not reported in the available educational summary.

Postoperative imaging

Postoperative cervical MRI demonstrated decompression at the operated cervical levels. Imaging should be shown only after complete de-identification.

Educational point

This case illustrates the use of endoscopic posterior cervical decompression for multilevel cervical spondylotic myelopathy. In cervical myelopathy, the operative goal is not simply nerve-root decompression but adequate spinal cord decompression at the clinically concordant levels. During UBE cervical ULBD, careful orientation to laminar anatomy, ligamentous structures, the dura, and the spinal cord is essential. Because the cervical spinal cord is less tolerant of compression, traction, or instrument misdirection, controlled decompression and avoidance of blind instrument movement are critical technical considerations.

Published images and video

Media are identified by their public source. Journal figures open at the original source; operative video illustrates a technical example. Imaging and operative appearances do not measure pain relief, function, or durable fusion.

Clinical history

De-identified clinical history summary for cervical spondylotic myelopathy case.
De-identified clinical history summary for cervical spondylotic myelopathy.

preoperative imaging

De-identified preoperative cervical radiograph for CSM case.
De-identified preoperative cervical radiograph used for alignment assessment.
De-identified preoperative sagittal cervical MRI demonstrating cervical stenosis.
De-identified preoperative sagittal cervical MRI demonstrating multilevel cervical stenosis.
De-identified preoperative axial cervical MRI demonstrating cervical stenosis.
De-identified preoperative axial cervical MRI demonstrating cervical canal stenosis.

postoperative imaging

De-identified postoperative cervical radiograph after endoscopic cervical decompression.
De-identified postoperative cervical radiograph after endoscopic decompression.
De-identified postoperative sagittal cervical MRI after endoscopic decompression.
De-identified postoperative sagittal cervical MRI after endoscopic decompression.
De-identified postoperative axial cervical MRI after decompression.
De-identified postoperative axial cervical MRI after decompression at the operated level.

Reported observations and missing data

Values below are limited to what the identified public source reports; source charts were not re-audited for this website update. Operative-time definitions and observation windows may differ. Do not compare these values across surgeons or procedures.

Operative time
Approximately 50 minutes.
Estimated blood loss
Approximately 100 mL.
Hospital stay
Not reported in the available educational summary.
Complications
Not reported in the available educational summary.
Follow-up interval
Not reported in the available educational summary.
Validated patient-reported outcome scores
Not reported in the available educational summary.

Evidence and further reading

These sources provide clinical context. They are separate from the source records for this case and do not verify its outcome.

  1. External evidence · clinical guideline

    A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy

    Fehlings MG et al. Global Spine J. 2017;7(3 Suppl):70S–83S.

    Recommendations organize management by myelopathy severity, progression, and the presence of cord compression.

    Applicability: A management guideline does not endorse a single endoscopic corridor. Alignment, instability, compression pattern, and the individual examination remain relevant.

  2. External evidence · clinical practice recommendations

    AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy

    Fehlings MG et al. Global Spine J. 2025;15(5):2585–2593.

    A 2025 evidence review of decision-making in degenerative cervical myelopathy.

    Applicability: Use alongside the cited source and individual clinical assessment. It is not a study of the cases presented on this site.

Source, authorship, and limitations

Source material: Hanjin Jang, MD academic case collection. Case 05 in the previously published Case-Based Education collection by Hanjin Jang, MD. A separate case-level clinical review date and public consent record are not reported in the available source. This entry was organized on 2026-09-11; this date records a website update, not a new clinical review.

Selection is educational. No population denominator, consecutive recruitment process, comparative group, or complete follow-up dataset is supplied. A missing complication field does not mean that no complication occurred. Published observations do not predict another patient's outcome.

No new private patient files were added in this update. Corrections and future clinical additions follow the editorial policy.

Suggested citation: Hanjin Jang, MD academic case collection. UBE Cervical ULBD for CSM. Casebank, Case 05. Updated 2026-09-11. https://www.hanjinjangspine1.com/casebank/cervical-myelopathy-endoscopic-decompression

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