Transoral Spine Surgery – an Update

Abstract

Even though in recent years the number of transoral spinal interventions has decreased in Europe and North America – mainly because of the progress in the drug therapy of rheumatism, there are still pathologies that can only be addressed by a transoral approach. The classical transoral approach can be expanded in collaboration with oral-maxillofacial surgery and ear, nose and throat surgery, but this is rarely necessary. The transoral approach is now mainly used for resection of pathological tissue. Additional stabilisation is often necessary and is performed in Europe and North America via a posterior approach, due to the lack of availability of anterior plate systems. Anterior plate systems are still used in India and China. In these countries, the numbers of transoral operations are generally still increasing. Today the indications for transoral spinal surgery consist mainly of infections and tumours, and more rarely of trauma and congenital malformations of the craniocervical junction. The numbers of surgical interventions for these indications has remained constant in recent years. The most recent advancement is the use of endoscopes and transnasal access. With these techniques, additional alternatives and supplements are available for further reducing the morbidity of transoral surgery. Despite the low number of cases, surgical therapy of the corresponding pathologies can be offered to patients with a calculable risk.

Key words

transoral approach - craniocervical junction - transnasal access - anterior plate systems

• References/Literatur

• 1 Kanaval A. Bullet located between the atlas and the base of the skull. Surg Clin Chicago 1917; 1: 361-366
• 2 Fang HS, Ong GB. Direct anterior approach to the upper cervical spine. J Bone Joint Surg Am 1962; 44 A: 1588-1604
• 3 Grison C. [Direct surgical approach by oral route to the first 2 cervical vertebrae]. J Fr Otorhinolaryngol Audiophonol Chir Maxillofac 1967; 16: 271-273
• 4 Greenberg AD, Scoville WB, Davey LM. Transoral decompression of atlantoaxial dislocation due to odontoid hypoplasia. Report of two cases. J Neurosurg 1968; 28: 266-269
• 5 Menezes AH, VanGilder JC, Graf CJ. et al. Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 1980; 53: 444-455
• 6 Crockard HA. The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg EngI 1985; 67: 321-325
• 7 Schmelzle R, Harms J, Stoltze D. Osteosynthesen im occipito-cervicalem Übergang vom transoralen Zugang aus. XVII SICOT World Congress Abstracts. Munich: Demeter; 1987: 32-33
• 8 Yamazaki M, Okawa A, Furuya T. et al. Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976) 2012; 37: E1389-E1397 doi:10.1097/BRS.0b013e31826a0c9f
• 9 Hadley MN, Martin NA, Spetzler RF. et al. Comparative transoral dural closure techniques: a canine model. Neurosurgery 1988; 22: 392-397
• 10 Crockard HA. Transoral surgery: some lessons learned. Br J Neurosurg 1995; 9: 283-293
• 11 Vaccaro AR, Baron EM. Operative Techniques: Spine Surgery. 2nd ed.. Philadelphia: Elsevier Saunders; 2012
• 12 Crockard HA. Transclival surgery. Br J Neurosurg 1991; 5: 237-240
• 13 Crockard HA, Pozo JL, Ransford AO. et al. Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. J Bone Joint Surg Br 1986; 68: 350-356
• 14 Grob D, Magerl F. [Surgical stabilization of C1 and C2 fractures]. Orthopade 1987; 16: 46-54
• 15 Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 1994; 129: 47-53
• 16 Harms J, Melcher RP. Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 2001; 15: 2467-2471
• 17 Nagahama K, Sudo H, Abumi K. Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine. Bone Joint J 2014; 96-B: 535-540
• 18 Kandziora F, Kerschbaumer F, Mittlmeier T. Stage related surgery for cervical spine instability in rheumatoid arthritis. Eur Spine J 1999; 6: 371-381
• 19 Kandziora F, Kerschbaumer F, Starker M. et al. Biomechanical assessment of transoral plate fixation for atlantoaxial instability. Spine (Phila Pa 1976) 2000; 25: 1555-1561
• 20 Harrop J, Schmidt M, Boriani S. et al. Aggressive “benign” primary spine neoplasms. Spine (Phila Pa 1976) 2009; 22: 39-47
• 21 Crockard HA, Sen CN. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery 1991; 28: 88-98
• 22 Menezes AH. Surgical approaches: postoperative care and complications “posterolateral-far lateral transcondylar approach to the ventral foramen magnum and upper cervical spinal canal”. Childs Nerv Syst 2008; 24: 1203-1207
• 23 Shriver MF, Kshettry VR, Sindwani R. Transoral and transnasal odontoidectomy complications: a systematic review and meta-analysis. Clin Neurol Neurosurg 2016; 148: 121-129
• 24 Dlouhy BJ, Dahdaleh NS, Menezes AH. Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update. Neurosurg Focus 2015; 38: E8
• 25 Frempong-Boadu AK, Faunce WA, Fessler RG. Endoskopically assisted transoral-transpharyngeal approach to the craniovertebral junction. Neurosurgery 2002; 51 (Suppl. 05) S60-S66
• 26 Husain M, Rastogi M, Ojha BK. et al. Endoscopic transoral surgery for craniovertebral junction anomalies. Technical note. J Neurosurg Spine 2006; 5: 367-373
• 27 Yadav YR, Madhariya SN, Parihar VS. et al. Endoscopic transoral excision of odontoid process in irreducible atlantoaxial dislocation: our experience of 34 patients. J Neurol Surg A Cent Eur Neurosurg 2013; 74: 162-167
• 28 Liu JK, Das K, Weiss MH. et al. The history and evolution of transsphenoidal surgery. J Neurosurg 2001; 95: 1083-1096
• 29 Kassam AB, Snyderman C, Gardner P. et al. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 2005; 57 (Suppl. 01) E213
• 30 Southwick WO, Robinson RA. Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Joint Surg 1957; 39-A: 631-644
• 31 Choi D, Crockard HA. Evolution of transoral surgery: three decades of change in patients, pathologies, and indications. Neurosurgery 2013; 73: 296-303
• 32 Fessler RG, Sekhar L. Atlas of neurosurgical Techniques: Spine and peripheral Nerves. Stuttgart: Thieme; 2006
• 33 Jeszenszky D, Fekete TF, Melcher R. C2 prosthesis: anterior upper cervical fixation device to reconstruct the second cervical vertebra. Eur Spine J 2007; 16: 1695-1700
• 34 Ma W, Xu N, Hu Y. Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach. Eur Spine J 2013; 22: 2232-2239
• 35 Hu Y, Albert TJ, Kepler CK. Unstable Jefferson fractures: results of transoral osteosynthesis. Indian J Orthop 2014; 48: 145-151