Minimally Invasive Decompression and Fusion With Percutaneous Facet Cages vs Traditional Lateral Mass Screw Fixation for Cervical Spondylotic Myelopathy: A Retrospective Comparative Study.

BACKGROUND Comparative clinical data evaluating percutaneous facet cage (PFC)-based minimally invasive decompression against traditional laminectomy and lateral mass screw (LMS) fixation in patients with cervical spondylotic myelopathy (CSM) remain limited. We compared the clinical and radiological outcomes of these 2 surgical strategies. MATERIAL AND METHODS We retrospectively reviewed 76 patients with CSM operated on between 2020 and 2024. Patients were categorized into 2 groups: the LMS group (n=46): laminectomy with LMS fusion; and the PFC group (n=30): speculum-assisted laminotomy with PFC fusion. Clinical outcomes were assessed using modified Japanese Orthopaedic Association, Neck Disability Index (NDI), visual analog scale (VAS), and Oswestry Disability Index (ODI) scores. Radiological parameters included cervical lordosis, T1 slope, cervical sagittal vertical axis, foraminal height, and fusion rate. Complications and perioperative data were compared. RESULTS The PFC group had better perioperative outcomes and numerically fewer complications, and achieved superior NDI, VAS, and ODI scores at 1 year, while both groups improved significantly in all clinical outcomes. Radiologically, foraminal height increased significantly in the PFC group. No significant differences were found between the groups in terms of fusion rates, cervical sagittal vertical axis, or cervical lordosis. CONCLUSIONS In this retrospective cohort, minimally invasive decompression combined with PFC was associated with shorter operative time, lower blood loss, and shorter hospital stay than conventional laminectomy with LMS fixation. Neurological recovery and radiological outcomes were comparable between groups, while pain and disability scores favored the PFC group. Minimally invasive decompression with PFC fusion is a viable alternative for elderly patients, those with multiple comorbidities, or those at high risk of perioperative bleeding.