Endoscopic Endonasal Odontoidectomy with Anterior C1 Arch Preservation in Rheumatoid Arthritis: Long-Term Follow-Up and Further Technical Improvement by Anterior Endoscopic C1-C2 Screw Fixation and Fusion

Iacoangeli, Maurizio; Nasi, Davide; Colasanti, Roberto; Pan, Baogen; Re, Massimo; Rienzo, Alessandro Dı; Somma, Lucia di; Dobran, Mauro; Specchia, Nicola; Scerrati, Massimo

doi:10.1016/j.wneu.2017.08.063

Cited by 28 publications

(29 citation statements)

References 21 publications

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“…Of the seven patients, there were two patients that underwent anterior fusion, and five cases in which patients did not receive fusion. There were no radiologic signs of instability in either cohort [33]. While timing of posterior fusion may vary, more extensive research may circumvent the issue altogether, as we evaluate the necessity of posterior stabilization in patients who undergo ETO with an intact anterior arch of C1.…”

Section: Discussionmentioning

confidence: 94%

“…Odontoidectomy has evolved as investigations and innovation surrounding surgical techniques progress. [2,3,9,[32][33][34] Transnasal, transoral, and transcervical approaches are utilized in instances when access to the odontoid is necessary to treat ventral compression of the brainstem. [2,3,9,15,[32][33][34][35] (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Most commonly, stabilization is achieved by either posterior C1-C2 or occipito-cervical fusion. Depending on the patient's age, pathoanatomy, and the absence of preoperative occipitocervical instability, certain physicians may elect to not perform a posterior fusion [23,33]. Another consideration that may become increasingly relevant in the future of ETO surgery relates to a technical element of the procedure.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Transnasal Odontoidectomy: A Novel Technique in Orthopedic Surgery

Nimmons

Volkmer

Rizkalla

et al. 2019

SN Compr. Clin. Med.

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Purpose Over the past decade, a minimally invasive technique to address upper cervical spine pathology has been executed successfully within ENT and neurosurgical communities. One indication for this endoscopic transnasal surgery is to remove the odontoid process of C2. Methods We aim to provide a detailed description of the current state of endoscopic endonasal odontoidectomy (ETO) techniques through a systematic literature review. We also report the clinical course of a patient who underwent an ETO with involvement of an orthopedic spinal surgeon. It is our hope that by highlighting the feasibility and positive outcomes of this approach, it may propagate more broadly through the spine community. Results A 61-year-old male presented to clinic with complaints of neck pain that radiated into the right arm. He had a remote history of closed head injury as a professional boxer, as well as previous ACDF from C4 to C7. On exam, the patient was myelopathic with diffuse 4/5 weakness in all extremities. Imaging revealed a Type-1 odontoid fracture non-union and significant stenosis at the C1 level, with only 7.7 mm available for the cord. After conferring with an interdisciplinary team, the patient was indicated for C1 laminectomy with posterior spinal fusion of C1-C2 and endoscopic transnasal odontoidectomy. At 5-month follow-up, the patient has reported improved gait mechanics, absence of RUE paresthesias, and improved RUE strength. Conclusions ETO is a viable, safe alternative to previously used methods of odontoid resection. As familiarity with the procedure increases throughout the medical field, further research should determine the most effective methods of ameliorating known complications.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Transnasal Odontoidectomy: A Novel Technique in Orthopedic Surgery

Nimmons

Volkmer

Rizkalla

et al. 2019

SN Compr. Clin. Med.

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“…(2) severe obliquity of facet joint makes the placement of intrafacet spacer difficult or impossible, or (3) abnormal bony auto-fusion secondary to arthritis makes reduction impossible [6,9,20,22]. Under such circumstances, a second stage transoral odontoidectomy could be considered for patients with residual medulla and cervical spinal cord compression.…”

Section: Discussionmentioning

confidence: 99%

“…Basilar invagination (BI) is the most common congenital malformation of the craniovertebral junction (CVJ), and it is characterized by protrusion of the odontoid process into the foramen magnum leading to ventral compression of the spinal cord [1][2][3][4][5]. BI is often associated with atlantoaxial dislocation (AAD), atlas assimilation, Chiari malformation, and other congenital anomalies [6,7]. For the treatment of BI, direct transoral decompression followed by posterior instrumentation had traditionally been a standard treatment for decades [3,4,[8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

Wang

Liu

et al. 2020

Chin Neurosurg Jl

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Background Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation. Methods Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Results Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported. Conclusion Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.

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Radiological assessment and surgical management of cervical spine involvement in patients with rheumatoid arthritis

et al. 2022

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The purpose of the present systematic review was to describe the diagnostic evaluation of rheumatoid arthritis in the cervical spine to provide a better understanding of the indications and options of surgical intervention. We performed a literature review of Pub-med, Embase, and Scopus database. Upon implementing specific inclusion and exclusion criteria, all eligible articles were identified. A total of 1878 patients with Rheumatoid Arthritis (RA) were evaluated for cervical spine involvement with plain radiographs. Atlantoaxial subluxation (AAS) ranged from 16.4 to 95.7% in plain radiographs while sub-axial subluxation ranged from 10 to 43.6% of cases. Anterior atlantodental interval (AADI) was found to between 2.5 mm and 4.61 mm in neutral and flexion position respectively, while Posterior Atlantodental Interval (PADI) was between 20.4 and 24.92 mm. 660 patients with RA had undergone an MRI. A pannus diagnosis ranged from 13.33 to 85.36% while spinal cord compression was reported in 0–13% of cases. When it comes to surgical outcomes, Atlanto-axial joint (AAJ) fusion success rates ranged from 45.16 to 100% of cases. Furthermore, the incidence of postoperative subluxation ranged from 0 to 77.7%. With regards to AADI it is evident that its value decreased in all studies. Furthermore, an improvement in Ranawat classification was variable between studies with a report improvement frequency by at least one class ranging from 0 to 54.5%. In conclusion, through careful radiographic and clinical evaluation, cervical spine involvement in patients with RA can be detected. Surgery is a valuable option for these patients and can lead to improvement in their symptoms.

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Endoscopic Endonasal Odontoidectomy with Anterior C1 Arch Preservation in Rheumatoid Arthritis: Long-Term Follow-Up and Further Technical Improvement by Anterior Endoscopic C1-C2 Screw Fixation and Fusion

Cited by 28 publications

References 21 publications

Endoscopic Transnasal Odontoidectomy: A Novel Technique in Orthopedic Surgery

Endoscopic Transnasal Odontoidectomy: A Novel Technique in Orthopedic Surgery

Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

Radiological assessment and surgical management of cervical spine involvement in patients with rheumatoid arthritis

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