Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

Abstract

Purpose This review aimed to describe the preoperative management and postoperative complications associated with transoral decompression of the upper cervical spine, and to clarify the risk factors, related issues and complication management. Methods Studies on transoral decompression for the upper cervical spine were reviewed systematically. The preoperative management and postoperative complications associated with transoral decompression for upper cervical deformities were analyzed. Results Evidence suggests that preoperative management in patients undergoing transoral decompression for the upper cervical spine is closely related to the occurrence of postoperative complications. Hence, preoperative surgical planning, preoperative preparation, and oral nursing care should be seriously considered in these patients. Moreover, while being established as an effective and safe method, transoral decompression is associated with several postoperative complications, which could be prevented by elaborate preoperative management, improved surgical skills, and appropriate precautionary measures. Conclusions The effectiveness and safety of transoral decompression has been improved by the constant development of operative techniques and advanced auxiliary diagnostic and therapeutic methods, with the understanding of the anatomical structure of the craniocervical joint. Therefore, the incidence rates of postoperative complications have decreased. The application of individualized anterior implants and less-invasive endoscopic endonasal approach has improved the effectiveness of transoral decompression and reduced the associated complications.

Traumatic posterior atlantoaxial dislocation without fracture of the odontoid process: illustrative case

“…CSF leak and secondary infectious meningitis are serious complications of a transoral approach. 32,33 In our case, the patient developed central nervous system infection postoperatively, and bacterial culture of CSF confirmed K. pneumoniae infection. We think there were three reasons for this: (1) Transoral odontoidectomy is not an aseptic operation; (2) before surgery, the patient received long-term treatment in the intensive care unit, underwent tracheotomy, and developed pneumonia; and (3) CSF exudation occurred during the operation.…”

Combined transmandibular approach for the resection of a cervical giant cell bone tumor: case report

“…However, it has several disadvantages, like the inferior limit and the fourth cervical vertebra, giving a limited working space. Another significant disadvantage is the oral cavity, which contains multiple germs, which increases the risk of contamination of the surgical field and, therefore, the risk of infection of the osteosynthesis materials, which could generate biofilm, conditioning a pseudoarthrosis and risk of abscesses 15 .…”

An Unusual Chordoma of the Odontoid Process: A Case Report and Literature Review

“…This technique can, however, potentially result in major complications, for example, cerebrospinal fluid leakage (6.2%), velopharyngeal incompetence (3.1%), wound infection (3.1%), sepsis (3.1%), dysphagia (3.1%), failure of fixation (2.1%), and vertebral artery stroke (1%). 17 , 39 , 40 …”

“…This technique can, however, potentially result in major complications, for example, cerebrospinal fluid leakage (6.2%), velopharyngeal incompetence (3.1%), wound infection (3.1%), sepsis (3.1%), dysphagia (3.1%), failure of fixation (2.1%), and vertebral artery stroke (1%). 17,39,40 As this case required adequate decompression and tumor removal, we used a combined transoral and posterior approach with microscopic assistance and administered sufficient intravenous antibiotics to prevent oral bacterial and flora infection. To avoid potential complications potentially affecting surrounding vital structures, we gently retracted the uvula with a rubber catheter.…”