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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Wound Infection | Review

Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

Authors: Wenqiang Li, Bingjin Wang, Xiaobo Feng, Wenbin Hua, Cao Yang

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Purpose

This review aimed to describe the preoperative management and postoperative complications associated with transoral decompression of the upper cervical spine, and to clarify the risk factors, related issues and complication management.

Methods

Studies on transoral decompression for the upper cervical spine were reviewed systematically. The preoperative management and postoperative complications associated with transoral decompression for upper cervical deformities were analyzed.

Results

Evidence suggests that preoperative management in patients undergoing transoral decompression for the upper cervical spine is closely related to the occurrence of postoperative complications. Hence, preoperative surgical planning, preoperative preparation, and oral nursing care should be seriously considered in these patients. Moreover, while being established as an effective and safe method, transoral decompression is associated with several postoperative complications, which could be prevented by elaborate preoperative management, improved surgical skills, and appropriate precautionary measures.

Conclusions

The effectiveness and safety of transoral decompression has been improved by the constant development of operative techniques and advanced auxiliary diagnostic and therapeutic methods, with the understanding of the anatomical structure of the craniocervical joint. Therefore, the incidence rates of postoperative complications have decreased. The application of individualized anterior implants and less-invasive endoscopic endonasal approach has improved the effectiveness of transoral decompression and reduced the associated complications.

Amelot A, Terrier LM, Lot G. Craniovertebral junction Transoral approach: predictive factors of complications. World Neurosurg. 2018;110:568–74.PubMedCrossRef

Perrini P, Benedetto N, Di Lorenzo N. Transoral approach to extradural non-neoplastic lesions of the craniovertebral junction. Acta Neurochir. 2014;156(6):1231–6.PubMed

Kotil K, Kalayci M, Bilge T. Management of cervicomedullary compression in patients with congenital and acquired osseous-ligamentous pathologies. J Clin Neurosci. 2007;14(6):540–9.PubMedCrossRef

Sar C, Eralp L. Transoral resection and reconstruction for primary osteogenic sarcoma of the second cervical vertebra. Spine (Phila Pa 1976). 2001;26(17):1936–41.CrossRef

Shaha AR, Johnson R, Miller J, Milhorat T. Transoral-transpharyngeal approach to the upper cervical vertebrae. Am J Surg. 1993;166(4):336–40.PubMedCrossRef

Salunke P, Behari S, Kirankumar MV, Sharma MS, Jaiswal AK, Jain VK. Pediatric congenital atlantoaxial dislocation differences between the irreducible and reducible varieties. J Neurosurg. 2006;104(2 Suppl):115–22.PubMed

Wu X, Wood K, Gao Y, Li S, Wang J, Ge T, et al. Surgical strategies for the treatment of os odontoideum with atlantoaxial dislocation. J Neurosurg Spine. 2018;28(2):131–9.PubMedCrossRef

Choi D, Melcher R, Harms J, Crockard A. Outcome of 132 operations in 97 patients with chordomas of the craniocervical junction and upper cervical spine. Neurosurgery. 2010;66(1):59–65 discussion 65.PubMedCrossRef

Kerschbaumer F, Kandziora F, Klein C, Mittlmeier T, Starker M. Transoral decompression, anterior plate fixation, and posterior wire fusion for irreducible atlantoaxial kyphosis in rheumatoid arthritis. Spine (Phila Pa 1976). 2000;25(20):2708–15.CrossRef

10.

Goel A, Bhatjiwale M, Desai K. Basilar invagination a study based on 190 surgically treated patients. J Neurosurg. 1998;88(6):962–8.PubMedCrossRef

11.

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.PubMedCrossRef

12.

Sawin PD, Menezes AH. Basilar invagination in osteogenesis imperfecta and related osteochondrodysplasias: medical and surgical management. J Neurosurg. 1997;86(6):950–60.PubMedCrossRef

13.

Kingdom TT, Nockels RP, Kaplan MJ. Transoral-transpharyngeal approach to the craniocervical junction. Otolaryngol Head Neck Surg. 1995;113(4):393–400.PubMedCrossRef

14.

Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS, Lisyansky IN, Makarov SN, et al. Transoral decompression and stabilization of the upper cervical segments of the spine using custom-made implants in various pathologic conditions of the Craniovertebral junction. World Neurosurg. 2018;109:e155–63.PubMedCrossRef

15.

Yin QS, Li XS, Bai ZH, Mai XH, Xia H, Wu ZH, et al. An 11-year review of the TARP procedure in the treatment of atlantoaxial dislocation. Spine (Phila Pa 1976). 2016;41(19):E1151–8.CrossRef

16.

Ai FZ, Yin QS, Xu DC, Xia H, Wu ZH, Mai XH. Transoral atlantoaxial reduction plate internal fixation with transoral transpedicular or articular mass screw of c2 for the treatment of irreducible atlantoaxial dislocation: two case reports. Spine (Phila Pa 1976). 2011;36(8):E556–62.CrossRef

17.

Yin QS, Ai FZ, Zhang K, Mai XH, Xia H, Wu ZH. Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation: a 2- to 4-year follow-up. Orthop Surg. 2010;2(2):149–55.PubMedPubMedCentralCrossRef

18.

Ai F, Yin Q, Wang Z, Xia H, Chang Y, Wu Z, et al. Applied anatomy of transoral atlantoaxial reduction plate internal fixation. Spine (Phila Pa 1976). 2006;31(2):128–32.CrossRef

19.

Yin Q, Ai F, Zhang K, Chang Y, Xia H, Wu Z, et al. Irreducible anterior atlantoaxial dislocation one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion. Report of 5 cases and review of the literature. Spine (Phila Pa 1976). 2005;30(13):E375–81.CrossRef

20.

Yang J, Ma X, Xia H, Wu Z, Ai F, Yin Q. Transoral anterior revision surgeries for basilar invagination with irreducible atlantoaxial dislocation after posterior decompression: a retrospective study of 30 cases. Eur Spine J. 2014;23(5):1099–108.PubMedCrossRef

21.

Steinberger J, Skovrlj B, Lee NJ, Kothari P, Leven DM, Guzman JZ, et al. Surgical morbidity and mortality associated with Transoral approach to the cervical spine. Spine (Phila Pa 1976). 2016;41(9):E535–40.CrossRef

22.

Menezes AH, VanGilder JC. Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J Neurosurg. 1988;69(6):895–903.PubMedCrossRef

23.

Menezes AH. Surgical approaches: postoperative care and complications “transoral-transpalatopharyngeal approach to the craniocervical junction”. Childs Nerv Syst. 2008;24(10):1187–93.PubMedCrossRef

24.

Hao DJ, He BR, Wu QN. One-stage anterior release and reduction with posterior fusion for treatment of irreducible atlantoaxial dislocation. Orthop Surg. 2009;1(4):305–10.PubMedPubMedCentralCrossRef

25.

Shkarubo AN, Andreev DN, Konovalov NA, Zelenkov PV, Lubnin AJ, Chernov IV, et al. Surgical treatment of Skull Base tumors, extending to Craniovertebral junction. World Neurosurg. 2017;99:47–58.PubMedCrossRef

26.

Hsu W, Wolinsky JP, Gokaslan ZL, Sciubba DM. Transoral approaches to the cervical spine. Neurosurgery. 2010;66(3 Suppl):119–25.PubMedCrossRef

27.

Varoni E, Tarce M, Lodi G, Carrassi A. Chlorhexidine (CHX) in dentistry: state of the art. Minerva Stomatol. 2012;61(9):399–419.PubMed

28.

Gondo T, Fujita K, Nagafuchi M, Obuchi T, Ikeda D, Yasumatsu R, et al. The effect of preventive oral care on postoperative infections after head and neck cancer surgery. Auris Nasus Larynx. 2020;47(4):643–9.PubMedCrossRef

29.

Plonowska KA, Ochoa E, Zebolsky AL, Patel N, Hoppe KR, Ha PK, et al. Nasogastric tube feeding after transoral robotic surgery for oropharynx carcinoma. Am J Otolaryngol. 2021;42(3):102857.PubMedCrossRef

30.

Marseu K, Slinger P. Peri-operative pulmonary dysfunction and protection. Anaesthesia. 2016;71(Suppl 1):46–50.PubMedCrossRef

31.

Wang C, Yan M, Zhou HT, Wang SL, Dang GT. Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine (Phila Pa 1976). 2006;31(11):E306–13.CrossRef

32.

Youssef AS, Sloan AE. Extended Transoral Approaches: Surgical Technique and Analysis. Neurosurgery. 2010;66(suppl_3):A126–34.CrossRef

33.

Jones DC, Hayter JP, Vaughan ED, Findlay GF. Oropharyngeal morbidity following transoral approaches to the upper cervical spine. Int J Oral Maxillofac Surg. 1998;27(4):295–8.PubMedCrossRef

34.

Yin Q, Xia H, Wu Z, Ma X, Ai F, Zhang K, et al. Surgical site infections following the Transoral approach: a review of 172 consecutive cases. Clin Spine Surg. 2016;29(10):E502–8.PubMedCrossRef

35.

Shousha M, Mosafer A, Boehm H. Infection rate after Transoral approach for the upper cervical spine. Spine. 2014;39(19):1578–83.PubMedCrossRef

36.

Xu ZW, Liu TJ, He BR, Guo H, Zheng YH, Hao DJ. Transoral anterior release, odontoid partial resection, and reduction with posterior fusion for the treatment of irreducible atlantoaxial dislocation caused by odontoid fracture malunion. Eur Spine J. 2015;24(4):694–701.PubMedCrossRef

37.

Mooney MA, Oppenlander ME, Kakarla UK, Theodore N. Tumoral calcinosis of the craniovertebral junction as a cause of dysphagia with treatment by transoral decompression: case report. J Neurosurg Spine. 2017;26(5):567–71.PubMedCrossRef

38.

Lee SH, Park K, Kong DS, Kim ES, Eoh W. Long-term follow up of transoral anterior decompression and posterior fusion for irreducible bony compression of the craniovertebral junction. J Clin Neurosci. 2010;17(4):455–9.PubMedCrossRef

39.

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 discussion 342.PubMed

40.

Zhang B, Liu H, Cai X, Wang Z, Xu F, Liu X, et al. Biomechanical comparison of modified TARP technique versus modified Goel technique for the treatment of basilar invagination: a finite element analysis. Spine (Phila Pa 1976). 2016;41(8):E459–66.CrossRef

41.

Dickman CA, Locantro J, Fessler RG. The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg. 1992;77(4):525–30.PubMedCrossRef

42.

Goel A. Progressive basilar invagination after transoral odontoidectomy treatment by atlantoaxial facet distraction and craniovertebral realignment. Spine (Phila Pa 1976). 2005;30(18):E551–5.CrossRef

43.

Tan M, Jiang X, Yi P, Yang F, Tang X, Hao Q, et al. Revision surgery of irreducible atlantoaxial dislocation: a retrospective study of 16 cases. Eur Spine J. 2011;20(12):2187–94.PubMedPubMedCentralCrossRef

44.

Xia H, Yin Q, Ai F, Ma X, Wang J, Wu Z, et al. Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J. 2014;23(8):1648–55.PubMedCrossRef

45.

Wang Z, Xia H, Wu Z, Ai F, Xu J, Yin Q. Detailed anatomy for the transoral approach to the craniovertebral junction: an exposure and safety study. J Neurol Surg B Skull Base. 2014;75(2):133–9.PubMedPubMedCentralCrossRef

46.

Mouchaty H, Perrini P, Conti R, Di Lorenzo N. Craniovertebral junction lesions: our experience with the transoral surgical approach. Eur Spine J. 2009;18(Suppl 1):13–9.PubMedPubMedCentralCrossRef

47.

Kandziora F, Mittlmeier T, Kerschbaumer F. Stage-related surgery for cervical spine instability in rheumatoid arthritis. Eur Spine J. 1999;8(5):371–81.PubMedPubMedCentralCrossRef

48.

Jain VK, Behari S, Banerji D, Bhargava V, Chhabra DK. Transoral decompression for craniovertebral osseous anomalies: perioperative management dilemmas. Neurol India. 1999;47(3):188–95.PubMed

49.

Landeiro JA, Boechat S, Christoph DH, Gonçalves MB, Castro I, Lapenta MA, et al. Transoral approach to the craniovertebral junction. Arq Neuropsiquiatr. 2007;65(4B):1166–71.PubMedCrossRef

50.

Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS. Transoral decompression and anterior stabilization of atlantoaxial joint in patients with basilar impression and Chiari malformation type I: a technical report of 2 clinical cases. World Neurosurg. 2017;102:181–90.PubMedCrossRef

51.

Li X, Ai F, Xia H, Wu Z, Ma X, Yin Q. Radiographic and clinical assessment on the accuracy and complications of C1 anterior lateral mass and C2 anterior pedicle screw placement in the TARP-III procedure: a study of 106 patients. Eur Spine J. 2014;23(8):1712–9.PubMedCrossRef

52.

Li XS, Wu ZH, Xia H, Ma XY, Ai FZ, Zhang K, et al. The development and evaluation of individualized templates to assist transoral C2 articular mass or transpedicular screw placement in TARP-IV procedures: adult cadaver specimen study. Clinics. 2014;69(11):750–7.PubMedPubMedCentralCrossRef

53.

Chibbaro S, Ganau M, Cebula H, Nannavecchia B, Todeschi J, Romano A, et al. The Endonasal endoscopic approach to pathologies of the anterior Craniocervical junction: analytical review of cases treated at four European neurosurgical Centres. Acta Neurochir Suppl. 2019;125:187–95.PubMedCrossRef

54.

Morales-Valero SF, Serchi E, Zoli M, Mazzatenta D, Van Gompel JJ. Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature. Neurosurg Focus. 2015;38(4):E15.PubMedCrossRef

55.

Hussain I, Schwartz TH, Greenfield JP. Endoscopic Endonasal approach to the upper cervical spine for decompression of the Cervicomedullary junction following Occipitocervical fusion. Clin Spine Surg. 2018;31(7):285–92.PubMedCrossRef

56.

Visocchi M, Di Martino A, Maugeri R, Gonzalez Valcarcel I, Grasso V, Paludetti G. Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. Eur Spine J. 2015;24(12):2713–23.PubMedCrossRef

57.

Zwagerman NT, Tormenti MJ, Tempel ZJ, Wang EW, Snyderman CH, Fernandez-Miranda JC, et al. Endoscopic endonasal resection of the odontoid process: clinical outcomes in 34 adults. J Neurosurg. 2018;128(3):923–31.PubMedCrossRef

58.

Zamorano L, Li Q, Jain S, Kaur G. Robotics in neurosurgery: state of the art and future technological challenges. Int J Med Robot. 2004;1(1):7–22.PubMedCrossRef

59.

Sethi RKV, Chen MM, Malloy KM. Complications of Transoral robotic surgery. Otolaryngol Clin N Am. 2020;53(6):1109–15.CrossRef

60.

Yee S. Transoral robotic surgery. AORN J. 2017;105(1):73–84.PubMedCrossRef

Title: Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine
Authors: Wenqiang Li
Bingjin Wang
Xiaobo Feng
Wenbin Hua
Cao Yang
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Wound Infection
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05081-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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