Dataset Information

Transoral Approach for Odontoidectomy Efficacy and Safety.

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.

SUBMITTER: Elbadrawi AM

PROVIDER: S-EPMC5617812 | biostudies-other | 2017 Oct

REPOSITORIES: biostudies-other

ACCESS DATA

Publications

Transoral Approach for Odontoidectomy Efficacy and Safety.

Elbadrawi Ahmed Mohamed AM Elkhateeb Tameem Mohamed TM

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20161205 3

<h4>Background</h4>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.<h4>Questions/purposes</h4>Our approach to anterior odontoid resection through transoral approach for different pathologies resulting in compression the cervical ...[more]

PMID: 28983222

Similar Datasets

Project description:Resection of the odontoid process and anterior arch of the atlas results in atlantoaxial instability, which if left uncorrected may lead to severe neurological complications. Currently, such atlantoaxial instability is corrected by anterior and/or posterior C1-C2 fusion. However, this results in considerable loss of rotation function of the atlantoaxial complex. From the viewpoint of retaining the rotation function and providing stability, we designed an artificial atlanto-odontoid joint based on anatomical measurements of 50 pairs of dry atlantoaxial specimens by digital calipers and 10 fresh cadaveric specimens by microsurgical techniques. The metal-on-metal titanium alloy joint has an arc-shaped atlas component, and a hollow cylindrical bushing into which fits a rotation axle of an inverted v-shaped axis component and is implanted through a transoral approach. After the joint was implanted onto specimens with anterior decompression, biomechanical tests were performed to compare the stability parameters in the intact state, after decompression, after artificial joint replacement, and after fatigue test. Compared to the intact state, artificial joint replacement resulted in a significant decrease in the range of motion (ROM) and neutral zone (NZ) during flexion, extension, and lateral bending (P < 0.001); however, with regard to axial rotation, there was no significant difference in ROM (P = 0.405), a significant increase in NZ (P = 0.008), and a significant decrease in stiffness (P = 0.003). Compared to the decompressed state, artificial joint replacement resulted in a significantly decreased ROM (P B 0.021) and NZ (P B 0.002) and a significantly increased stiffness (P \ 0.001) in all directions. Following artificial joint replacement, there was no significant difference in ROM (P C 0.719), NZ (P C 0.580), and stiffness (P C 0.602) in all directions before and after the fatigue test. The artificial joint showed no signs of wear and tear after the fatigue test. This artificial atlanto-odontoid joint may be useful in cases of odontoid resection due to malunion or nonunion of odontoid fracture, atraumatic odontoid fracture, irreducible atlas dislocation, posterior atlantoaxial subluxation, or congenital skull base abnormalities.

Dataset Information

Transoral Approach for Odontoidectomy Efficacy and Safety.

Publications

Transoral Approach for Odontoidectomy Efficacy and Safety.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets