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Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique.
Spine (Phila Pa 1976). 2009 Feb 15; 34(4):E139-43.S

Abstract

STUDY DESIGN

We report the case of a 50 year-old woman with os odontoideum and posterior atlantoaxial subluxation, who underwent an occipitocervical fusion followed by endonasal endoscopic anterior decompression of the cervicomedullary junction (CMJ).

OBJECTIVE

To describe the feasibility of performing endonasal endoscopic anterior decompression of CMJ pathology in conjunction with occipitocervical fusion in 1 operative setting.

SUMMARY OF BACKGROUND DATA

The recommended management of symptomatic atlantoaxial instability secondary to os odontoideum with irreducible ventral compression is occipitocervical fusion with anterior decompression. The traditional method for anterior decompression of CMJ abnormalities is the transoral approach. The endonasal endoscopic approach is an emerging minimal access technique that reduces the potential morbidity of the transoral approach.

METHODS

The patient underwent an occipitocervical fusion and anterior decompression in 1 operative setting. Occiput to C5 fusion was first undertaken in the prone position. After a wake-up test, the patient was flipped into a supine position for the endonasal endoscopic procedure. Anterior decompression was achieved by resecting the anterior arch of C1 and the os odontoideum with the aid of frameless stereotactic navigation.

RESULTS

The patient tolerated the procedure well and was extubated on the first postoperative day. Liquids were started that afternoon and advanced to a regular diet on the second postoperative day. The patient was discharged to rehabilitation after a short postoperative stay. Postoperative imaging demonstrated excellent decompression of the anterior CMJ pathology. At 3-month follow-up, the patient showed clear improvements in hand strength and ability to ambulate.

CONCLUSION

The endonasal endoscopic approach to the CMJ provides an effective and minimally invasive alternative for anterior decompression of irreducible CMJ pathology.

Authors+Show Affiliations

Department of Neurosurgery, Weill Cornell Medical College, NY Presbyterian Hospital, New York, NY, USA. lel9021@nyp.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19214083

Citation

Leng, Lewis Z., et al. "Endonasal Endoscopic Resection of an Os Odontoideum to Decompress the Cervicomedullary Junction: a Minimal Access Surgical Technique." Spine, vol. 34, no. 4, 2009, pp. E139-43.
Leng LZ, Anand VK, Hartl R, et al. Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique. Spine (Phila Pa 1976). 2009;34(4):E139-43.
Leng, L. Z., Anand, V. K., Hartl, R., & Schwartz, T. H. (2009). Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique. Spine, 34(4), E139-43. https://doi.org/10.1097/BRS.0b013e31818e344d
Leng LZ, et al. Endonasal Endoscopic Resection of an Os Odontoideum to Decompress the Cervicomedullary Junction: a Minimal Access Surgical Technique. Spine (Phila Pa 1976). 2009 Feb 15;34(4):E139-43. PubMed PMID: 19214083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endonasal endoscopic resection of an os odontoideum to decompress the cervicomedullary junction: a minimal access surgical technique. AU - Leng,Lewis Z, AU - Anand,Vijay K, AU - Hartl,Roger, AU - Schwartz,Theodore H, PY - 2009/2/14/entrez PY - 2009/2/14/pubmed PY - 2009/4/21/medline SP - E139 EP - 43 JF - Spine JO - Spine (Phila Pa 1976) VL - 34 IS - 4 N2 - STUDY DESIGN: We report the case of a 50 year-old woman with os odontoideum and posterior atlantoaxial subluxation, who underwent an occipitocervical fusion followed by endonasal endoscopic anterior decompression of the cervicomedullary junction (CMJ). OBJECTIVE: To describe the feasibility of performing endonasal endoscopic anterior decompression of CMJ pathology in conjunction with occipitocervical fusion in 1 operative setting. SUMMARY OF BACKGROUND DATA: The recommended management of symptomatic atlantoaxial instability secondary to os odontoideum with irreducible ventral compression is occipitocervical fusion with anterior decompression. The traditional method for anterior decompression of CMJ abnormalities is the transoral approach. The endonasal endoscopic approach is an emerging minimal access technique that reduces the potential morbidity of the transoral approach. METHODS: The patient underwent an occipitocervical fusion and anterior decompression in 1 operative setting. Occiput to C5 fusion was first undertaken in the prone position. After a wake-up test, the patient was flipped into a supine position for the endonasal endoscopic procedure. Anterior decompression was achieved by resecting the anterior arch of C1 and the os odontoideum with the aid of frameless stereotactic navigation. RESULTS: The patient tolerated the procedure well and was extubated on the first postoperative day. Liquids were started that afternoon and advanced to a regular diet on the second postoperative day. The patient was discharged to rehabilitation after a short postoperative stay. Postoperative imaging demonstrated excellent decompression of the anterior CMJ pathology. At 3-month follow-up, the patient showed clear improvements in hand strength and ability to ambulate. CONCLUSION: The endonasal endoscopic approach to the CMJ provides an effective and minimally invasive alternative for anterior decompression of irreducible CMJ pathology. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/19214083/Endonasal_endoscopic_resection_of_an_os_odontoideum_to_decompress_the_cervicomedullary_junction:_a_minimal_access_surgical_technique_ L2 - https://doi.org/10.1097/BRS.0b013e31818e344d DB - PRIME DP - Unbound Medicine ER -