Endoscopic Odontoidectomy and Adjuvant Cervical Fusion Surgery: A Single Surgical Center Experience

Introduction: The development of instability and compression in the craniovertebral junction from various developmental and acquired pathologies necessitates surgery of the odontoid. Although odontoidectomy with posterior instrumented arthrodesis has been described previously, the timing of arthrodesis has rarely been described. We report a single surgical center experience of odontoidectomy followed by a planned staged surgery for posterior cervical spine fixation.

Methods: An IRB-approved retrospective chart review of 11 patients that underwent odontoidectomy at Thomas Jefferson University Hospital between 2009 and 2021 was completed. Demographics, disease pathology, surgical course, and complications were obtained from electronic medical records.

Results: Eleven patients (eight men and three females) were included, with a mean age of 64.1 years (range: 42–88 years), mean BMI of 24.3 kg/m² (range: 19.6–48.2 kg/m²), and mean follow-up time of 167.9 days (range: 19–3,604 days). The indications for odontoidectomy were infectious pathology (n = 6), chordoma (n = 2), fracture (n = 1), radionecrosis of the craniocervical junction (n = 1), and pseudotumor (n = 1). Cultures of the infectious processes showed the presence of various pathogens including gram-positive bacteria, gram-negative bacteria, and fungi. Seven patients underwent endoscopic odontoidectomy first followed by fusion of cervical spine as a separate procedure during the same hospital admission. All stabilizations of the cervical spine were completed using a posterior surgical approach with the patient in the prone position. The mean interval between odontoidectomy and fusion surgery was 3.1 days (range: 2–4 days) with all patients being placed in a cervical spine collar during this interim period. No complications were observed between the surgeries and no operative complications were detected from either surgery. One patient from this cohort required a second surgery 6 months later due to the presence of residual chordoma. In a total of four patients required a feeding tube. Due to the presence of previous posterior stabilization surgery of the craniovertebral junction, two patients did not have fixation after odontoidectomy; one patient had stabilization surgery 4 days before odontoidectomy due to extreme debilitation and concern for patient safety; one patient had odontoidectomy with no fixation surgery due to the solid fusion of the occiput to C2 before odontoidectomy that posed little risk of destabilization.

Conclusion: Delayed posterior cervical stabilization following odontoidectomy has several logistical advantages to two major surgeries in the same setting and may result in less swelling, bleeding, and shorter anesthesia. Patients seem to tolerate the two shorter procedures well. Our experience shows that patients may be safely maintained in a cervical spine collar between the two surgeries.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022