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Infection Rate After Transoral Approach for the Upper Cervical Spine

Shousha, Mootaz MD*,†; Mosafer, Azim MD*; Boehm, Heinrich MD*

doi: 10.1097/BRS.0000000000000475
Cervical Spine

Study Design. A retrospective review of prospectively collected databases of 139 consecutive patients who underwent transoral surgery for lesions of the upper cervical spine.

Objective. To analyze the incidence and risk factors of local infection after transoral surgery for the craniocervical junction in a single institution and to compare the findings with the literature.

Summary of Background Data. One of the primary risks associated with transoral approach for lesions in the upper cervical spine is postoperative surgical wound infection.

Methods. From April 1994 to December 2012, 139 consecutive transoral surgical procedures were performed at a single referral center. The mean age at presentation was 53.6 years (range: 5–87 yr), and more than half of the patients were males (58.3%). The majority of cases were experiencing rheumatic diseases (43.9%), whereas tumor destruction was the indication for surgery in 23.7% of the cases. A total of 23% had fracture of the upper cervical spine and primary infection was found in 7 patients (5%). The mean follow-up period was 4.5 years.

Results. Infection of the pharyngeal wound occurred in 5 patients (3.6%), solely in the rheumatic and tumor groups. The presentation was mostly in the first 4 months. A single patient with cage reconstruction after giant cell tumor C2 presented with a late infection 5 years postoperatively. Debridement and primary closure was possible in 2 patients, whereas flap coverage of the pharyngeal wall was necessary in 3 patients. The presence of implant did not have a statistically significant effect on the occurrence of infection. However, infection in the presence of titanium cage mostly necessitated flap coverage of the pharyngeal wall after removal of the cage.

Conclusion. The transoral route has proved to be an invaluable method of approaching pathological lesions in the upper cervical spine. The infection rate in this work was 3.6%. Patients with rheumatic diseases and patients presenting with tumors were more susceptible to postoperative surgical wound infection.

Level of Evidence: 4

A total of 139 cases undergoing transoral surgery for lesions in the upper cervical spine were reviewed. Five patients experienced postoperative pharyngeal wound infection and presented mostly in the first 4 months. Surgical debridement was performed in all of them, whereas flap coverage of the pharyngeal wall was necessary in 3 patients.

*Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany; and

Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt.

Address correspondence and reprint requests to Mootaz Shousha, MD, Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany; E-mail:

Acknowledgment date: February 16, 2014. Revision date: May 24, 2014. Acceptance date: May 29, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, patents, and royalties.

© 2014 by Lippincott Williams & Wilkins