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Full-endoscopic Uniportal Odontoidectomy and Decompression of the Anterior Cervicomedullary Junction Using the Retropharyngeal Approach

Ruetten, Sebastian MD; Hahn, Patrick MD; Oezdemir, Semih MD; Baraliakos, Xenophon MD; Merk, Harry MD; Godolias, Georgios MD§; Komp, Martin MD

doi: 10.1097/BRS.0000000000002561
SURGERY
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Study Design. A study of a series of consecutive full-endoscopic uniportal decompressions of the anterior craniocervical junction with retropharyngeal approach.

Objective. The aim of this study was to evaluate the direct anterior decompression of the craniocervical junction in patients with bulbomedullary compression using a full-endoscopic uniportal technique via an anterolateral retropharyngeal approach.

Summary of Background Data. Acute or progressive myelopathy may necessitate direct anterior decompression of the craniocervical junction and odontoidectomy. Different techniques with individual advantages and disadvantages can be used. In addition to the gold standard – the transoral approach – there is increasing experience with the endoscopic transnasal technique. Other alternative procedures are also being developed.

Methods. Between 2013 and 2016, eight patients with basilar impression, retrodental pannus, or retrodental infection were operated in the full-endoscopic uniportal technique with a retropharyngeal approach. Anterior decompression of the bulbomedullary junction with odontoidectomy was performed. All patients additionally underwent posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 1 year.

Results. The bulbomedullary junction was adequately decompressed. No problems due to swelling of pharyngeal soft tissue occurred. One patient required revision due to secondary bleeding. No other complications were observed. All patients had a good clinical outcome with stable regression of the myelopathy symptoms and/or healing of the infection. The imaging follow-up showed sufficient decompression of bone and soft tissue in all cases. No evidence was found of increasing instability or failure of posterior fusion.

Conclusion. In the operated patients, the full-endoscopic uniportal surgical technique with anterior retropharyngeal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation. It should not be viewed only as competition for other surgical techniques – due to its individual technical parameters, it can also be considered to be an alternative or complementary procedure.

Level of Evidence: 4

Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group – Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany

Center for Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr University of Bochum, Herne, Germany

Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany

§Center for Orthopedics and Traumatology of the St. Elisabeth Group – Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University Bochum/Marien Hospital Witten, Herne, Germany

Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group – Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne, University of Witten/Herdecke, Herne, Germany.

Address correspondence and reprint requests to Sebastian Ruetten, MD, Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group – Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstrasse 19, 44649 Herne, Germany; E-mail: info@s-ruetten.com

Received 23 October, 2017

Revised 7 December, 2017

Accepted 28 December, 2017

The manuscript submitted does not contain information about medical devices/drugs.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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