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Transoral Approach for Odontoidectomy Efficacy and Safety

  • Surgical Technique
  • Published:
HSS Journal ®

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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Authors and Affiliations

  1. Department of Orthopedics and Spine Surgery, Ain Shams University, Cairo, Egypt

    Ahmed Mohamed Elbadrawi MD & Tameem Mohamed Elkhateeb MD

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  1. Ahmed Mohamed Elbadrawi MD
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  2. Tameem Mohamed Elkhateeb MD
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Correspondence to Tameem Mohamed Elkhateeb MD.

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Conflict of Interest

Ahmed Mohamed Elbadrawi, MD, and Tameem Mohamed Elkhateeb, MD, have declared that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all patients for being included in the study.

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Level of Evidence: Therapeutic Study Level IV

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Elbadrawi, A.M., Elkhateeb, T.M. Transoral Approach for Odontoidectomy Efficacy and Safety. HSS Jrnl 13, 276–281 (2017). https://doi.org/10.1007/s11420-016-9535-3

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