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HSS Journal ®
Published in: HSS Journal ® 3/2017

01-10-2017 | Surgical Technique

Transoral Approach for Odontoidectomy Efficacy and Safety

Authors: Ahmed Mohamed Elbadrawi, MD, Tameem Mohamed Elkhateeb, MD

Published in: HSS Journal ® | Issue 3/2017

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Abstract

Background

Odontoid process pathologies can cause upper motor neuron lesions. These pathologies can be approached through either a high retropharyngeal approach or a transoral approach. The introduction of the surgical microscope, proper instrumentations, and proper antibiotics has increased utilization of the transoral approach.

Questions/Purposes

Our approach to anterior odontoid resection through transoral approach for different pathologies resulting in compression the cervical cord or causing craniocervical instability is described here. We aim to explore the safety and efficacy of this approach.

Methods

Twenty cases of different odontoid pathologies were managed by transoral surgery. Patients were assessed clinically for axial neck pain and radicular symptoms using visual analog scale. The Nurick score was used to get an overall functional evaluation of the difficulty of ambulation and walking. Radiological evaluation of the patients included plain radiographs, CT scans, and MRI of the cervical spine. Posterior surgery was done as a first stage for restoring the sagittal profile of the cervical spine. Transoral surgery was done as a second stage for odontoid resection and anterior decompression of the cord.

Results

Average follow-up was 29.4 ± 3.8 months. Mean preoperative Nurick scale was 1.3 ± 1.2. Mean postoperative Nurcik scale was 0.5 ± 0.61. Patients with axial neck pain were improved after surgery except the 6 patients; mean VAS preoperative 8.2 ± 2.3 SD, mean postoperative VAS 3.7 ± 0.8SD, and radicular symptoms were not significantly changed after surgery; gait changes were improved in all patients with preoperative gait disturbance.

Conclusion

The transoral approach is a safe and effective surgical method for the direct decompression of ventral midline extradural compressive disease of the craniovertebral junction.
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Literature
1.
Al-Mefty O, Borba LA, Aoki N, et al. The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction. J Neurosurg. 1996; 84: 1-6.CrossRefPubMed
2.
Apuzzo ML, Weiss MH, Heiden JS. Transoral exposure of the atlantoaxial region. Neurosurgery. 1978; 3: 201-207.CrossRefPubMed
3.
4.
Crockard HA.The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Engl. 1985; 67(5):321-5.
5.
Crockard HA. Ventral approaches to the upper cervical spine. Orthopade. 1991; 20: 140-146.PubMed
6.
7.
Crockard HA, Calder I, Ransford AO. One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation. J Bone Joint Surg (Br). 1990; 72: 682-685.
8.
Crockard HA, Essigman WK, Stevens JM, et al. Surgical treatment of cervical cord compression in rheumatoid arthritis. Ann Rheum Dis. 1985; 44(12): 809-816.CrossRefPubMedPubMedCentral
9.
Crockard HA, Johnston F. Development of transoral approaches to lesions of the skull base and craniocervical junction. Neurosurg Q. 1993; 3: 61-82.
10.
Dickman CA, Apostolides PJ, Karahalios DG. Surgical techniques for upper cervical spine decompression and stabilization. Clin Neurosurg. 1997; 44: 137-160. PMID: 10080006, Review.PubMed
11.
Dickman CA, Apostolides PJ, Marciano FF: Transoral approach to the craniovertebral junction, in Zdeblick T (ed): Anterior Approaches to the Spine. St. Louis, Quality Medical Publishing. 2016; (in press).
12.
Dickman CA, Spetzler RF, Sonntag VKH, et al. Transoral approach to the craniovertebral junction. In: Dickman CA, Spetzler RF, Sonntag VKH, eds. Surgery of the craniovertebral junction. New York: Thieme; 1998.
13.
Bouramas D, Crockard A. Surgical techniques for the spine. Haher TR, Merola AA (Hrsg.), Surgical Techniques for the Spine (ISBN 3131247614) © 2003 Georg Thieme Verlag.
14.
Dziurzynski K, Anderson PA, Bean DB, et al. A blinded assessment of radiographic criteria for atlanto-occipital dislocation. Spine (Phila Pa 1976). 2005; 30(12): 1427-1432.CrossRef
15.
Fang HSY, Ong GB. Direct anterior approach to the upper cervical spine. J Bone Joint Surg Am. 1962; 44-A: 1588-1604.CrossRef
16.
Gladi M, Iacoangeli M, Specchia N, et al. Endoscopic transnasal odontoid resection to decompress the bulbo-medullary junction: a reliable anterior minimally invasive technique without posterior fusion. Eur Spine J. 2012; 21(Suppl 1): S55-S60. doi:10.​1007/​s00586-012-2220-4.CrossRefPubMed
17.
Hadley MN, Spetzler RF, Sonntag VK. The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression. J Neurosurg. 1989; 71(1): 16-23.CrossRefPubMed
18.
Harris JP, Godin MS, Krekorian TD, et al. The transoropalatal approach to the atlanto-clival region: considerations of the head and neck surgeon. Laryngoscope. 1989; 99: 467-474.CrossRefPubMed
19.
James D, Crockard HA. Surgical access to the base of skull and upper cervical spine by extended maxillotomy. Neurosurgery. 1991; 29(3):411–6.
20.
Kanavel AB. Bullet locked between atlas and the base of the skull: technique for removal through the mouth. Surg Clin. 1919; 1: 361-366.
21.
Denaro L, D’Avella D, Longo UG, Denaro V. (Eds) Complications Related to Anterior Approaches. In Denaro L, D’Avella D, Denaro V. (Eds.) Pitfalls in Cervical Spine Surgery Avoidance and Management of Complications © Springer-Verlag Berlin Heidelberg 2010. pp. 81–91.
22.
Masferrer R, Hadley MN, Bloomfield S, Spetzler RF, Sonntag VKH. Transoral microsurgical resection of the odontoid process. BNI Quarterly. 1(3):34–40, 1985.
23.
Menezes AH. Transoral approaches to the clivus and upper cervical spine. In: Menezes AH, Sonntag VKH, eds. Principles of spinal surgery. New York: McGraw-Hill; 1996.
24.
Menezes AH. Tumors of the craniocervical junction. In: Menezes AH, Sonntag VKH, eds. Principles of spinal surgery. New York: McGraw Hill; 1996.
25.
Menezes AH, Folz G. Transoral approach to the ventral craniocervical border. Oper Tech Neurosurg. 2008; 8: 150-157.CrossRef
26.
Menezes AH, Traynelis VC, Gantz BJ. Surgical approaches to the craniovertebral junction. Clin Neurosurg. 1994; 41: 187-203.PubMed
27.
Menezes AH, VanGilder JC. Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J Neurosurg. 1988; 69: 895-903.CrossRefPubMed
28.
Menezes AH, VanGilder JC, Graf CJ, et al. Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg. 1980; 53: 444-455.CrossRefPubMed
29.
Mosberg WH Jr, Lippman EM. Anterior approach to the cervical vertebral bodies. Bull Sch Med Univ Md. 1960; 45: 10-17.PubMed
30.
31.
Perrini P, Benedetto N, Guidi E, Di Lorenzo N. Transoral approach and its superior extensions to the craniovertebral junction malformations: surgical strategies and results. Neurosurgery. 2009; 64(5 Suppl 2):331–42. doi:10.​1227/​01.​NEU.​0000334430.​25626.​DC.
32.
Robinson RA, Southwick WO. Surgical approaches to the cervical spine. Instr Course Lect. 1960; 17: 299-330.PubMed
33.
Scoville WB, Sherman IJ. Platybasia, report of 10 cases with comments on familial tendency, a special diagnostic sign, and the end results of operation. Ann Surg. 1951; 133: 496-502.CrossRefPubMedPubMedCentral
34.
Spetzler RF, Dickman CA, Sonntag VKH. The transoral approach to the anterior cervical spine. Contemp Neurosurg. 1991; 13: 1-6.CrossRef
35.
Spetzler RF, Hadley MN, Sonntag VK. The transoral approach to the anterior superior cervical spine. A review of 29 cases. Acta Neurochir. 1988; 43: 69-74. PMID: 3213660.
36.
Spetzler RF, Selman WR, Nash CL Jr, et al. Transoral microsurgical odontoid resection and spinal cord monitoring. Spine. 1979; 4: 506-510.CrossRefPubMed
37.
38.
Metadata
Title
Transoral Approach for Odontoidectomy Efficacy and Safety
Authors
Ahmed Mohamed Elbadrawi, MD
Tameem Mohamed Elkhateeb, MD
Publication date
01-10-2017
Publisher
Springer US
Published in
HSS Journal ® / Issue 3/2017
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-016-9535-3

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