Download PDF
Z Orthop Unfall 2019; 157(01): 82-93
DOI: 10.1055/a-0621-9430
Review
Georg Thieme Verlag KG Stuttgart · New York

Transoral Spine Surgery – an Update

Article in several languages: English | deutsch
Jens Castein
Center for Spinal Surgery and Neurotraumatology, BG Hospital, Frankfurt am Main
,
Christoph-Heinrich Hoffmann
Center for Spinal Surgery and Neurotraumatology, BG Hospital, Frankfurt am Main
,
Frank Kandziora
Center for Spinal Surgery and Neurotraumatology, BG Hospital, Frankfurt am Main
› Author Affiliations
Further Information

Publication History

Publication Date:
03 July 2018 (online)

Also available at
    Permissions and Reprints

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
    PubMedGoogle Scholar
  • 2 Fang HS, Ong GB. Direct anterior approach to the upper cervical spine. J Bone Joint Surg Am 1962; 44 A: 1588-1604
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Menezes AH, VanGilder JC, Graf CJ. et al. Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 1980; 53: 444-455
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Hadley MN, Martin NA, Spetzler RF. et al. Comparative transoral dural closure techniques: a canine model. Neurosurgery 1988; 22: 392-397
    CrossrefPubMedGoogle Scholar
  • 10 Crockard HA. Transoral surgery: some lessons learned. Br J Neurosurg 1995; 9: 283-293
    CrossrefPubMedGoogle Scholar
  • 11 Vaccaro AR, Baron EM. Operative Techniques: Spine Surgery. 2nd ed.. Philadelphia: Elsevier Saunders; 2012
    Google Scholar
  • 12 Crockard HA. Transclival surgery. Br J Neurosurg 1991; 5: 237-240
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 14 Grob D, Magerl F. [Surgical stabilization of C1 and C2 fractures]. Orthopade 1987; 16: 46-54
    PubMedGoogle Scholar
  • 15 Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 1994; 129: 47-53
    CrossrefPubMedGoogle Scholar
  • 16 Harms J, Melcher RP. Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 2001; 15: 2467-2471
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Kandziora F, Kerschbaumer F, Mittlmeier T. Stage related surgery for cervical spine instability in rheumatoid arthritis. Eur Spine J 1999; 6: 371-381
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Harrop J, Schmidt M, Boriani S. et al. Aggressive “benign” primary spine neoplasms. Spine (Phila Pa 1976) 2009; 22: 39-47
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 25 Frempong-Boadu AK, Faunce WA, Fessler RG. Endoskopically assisted transoral-transpharyngeal approach to the craniovertebral junction. Neurosurgery 2002; 51 (Suppl. 05) S60-S66
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Liu JK, Das K, Weiss MH. et al. The history and evolution of transsphenoidal surgery. J Neurosurg 2001; 95: 1083-1096
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 31 Choi D, Crockard HA. Evolution of transoral surgery: three decades of change in patients, pathologies, and indications. Neurosurgery 2013; 73: 296-303
    CrossrefPubMedGoogle Scholar
  • 32 Fessler RG, Sekhar L. Atlas of neurosurgical Techniques: Spine and peripheral Nerves. Stuttgart: Thieme; 2006
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 35 Hu Y, Albert TJ, Kepler CK. Unstable Jefferson fractures: results of transoral osteosynthesis. Indian J Orthop 2014; 48: 145-151
    CrossrefPubMedGoogle Scholar