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Anterior Extraoral Surgery to the Upper Cervical Spine

Laus, Massimo, MD*; Pignatti, Giovanni, MD; Malaguti, Maria C., MD; Alfonso, Calogero, MD; Zappoli, Franco A., MD; Giunti, Armando, MD

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Study Design A series of 10 patients surgically treated with prevascular or retrovascular extraoral retropharyngeal approach to the upper cervical spine is examined.

Objectives In orthopedic surgery, retropharyngeal approach may replace the transoral surgery, obviating the risks of infection and the uncomfortable postoperative course of cases in which median labiomandibular glossotomy was used to accomplish complex bone reconstruction.

Summary of the Background Data The transoral approach is reported in literature as the classical anterior access to the upper cervical spine that provides direct exposure for anterior decompression of the spinal cord. The risks, the surgical limits, and the postoperative difficulties of transmucosal access suggest the use of an anterior extraoral retropharyngeal approach in orthopedic surgery.

Methods The series includes four neoplastic lesions (osteoma, aneurismal bone cyst, giant cell tumor, solitary metastasis), three retropharyngeal ossifications resulting from diffuse idiopathic skeletal hyperostosis, and a single case of os odontoideum, craniocervical malformation, and postlaminectomy kyphosis.

Results At follow-up evaluation, all patients achieved a satisfactory outcome, with good clinical and radiographic results; nasotracheal intubation obviated the need for tracheostomy. The wide surgical exposure allowed reconstruction with iliac strut bone grafts and internal fixation in six patients, avoiding the need of a halo device. The only complications were four instances of transient palsies of the marginal mandibular branch of the facial nerve.

Conclusions In the anterior surgery of the upper cervical spine, the prevascular approach allows a wide surgical exposure, with visualization similar to that obtained with median labiomandibular glossotomy. The retrovascular approach is indicated in selected cases, such as tumor adjacent to the vertebral artery and C1-C2 arthrodesis with bilateral transarticular screws according to Barbour.

From the *Orthopaedic Department, S. Orsola-Malpighi Hospital, Bologna, Italy, the Orthopaedic Department of the University of Bologna, Istituto Ortopedico Rizzoli, Bologna, and the Department of Radiology, Istituto Ortopedico Rizzoli, Bologna.

Acknowledgment date: April 7, 1995.

First revision date: July 31, 1995.

Acceptance date: November 13, 1995.

Device status category: 1.

Address reprint requests to: Massimo Laus, MD; Divisione di Ortopedia e Traumatologia; Policlinico S. Orsola - Malpighi; via Albertoni 15; 40138 Bologna, BO; Italy

© Lippincott-Raven Publishers.