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Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis.
Spine J. 2013 May; 13(5):542-8.SJ

Abstract

BACKGROUND CONTEXT

Rheumatoid arthritis is the most common inflammatory disease involving the spine with predilection for the craniovertebral segment. Surgery is usually reserved to patients with symptomatic craniovertebral junction (CVJ) instability, basilar invagination, or upper spinal cord compression by rheumatoid pannus. Anterior approaches are indicated in cases of irreducible ventral bulbo-medullary compression. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA).

PURPOSE

The aim of this article is to demonstrate the feasibility of performing an odontoidectomy and a rheumatoid pannus removal by a minimally invasive EEA, preserving the anterior C1 arch continuity and avoiding a posterior fixation procedure.

STUDY DESIGN

Technical description and cohort report.

METHODS

We report three cases of elderly patients with a long history of rheumatoid arthritis and irreducible anterior bulbo-medullary compression secondary to basilar invagination and/or rheumatoid pannus. Anterior decompression was achieved by an endonasal image-guided fully endoscopic approach.

RESULTS

Neurological improvement and adequate bulbo-medullary decompression were obtained in all cases. The anterior C1 arch continuity was preserved, and none of the patients required a subsequent posterior fixation.

CONCLUSIONS

Anterior decompression by a minimally invasive EEA could represent an innovative option for the treatment of irreducible ventral CVJ lesions in elderly patients with rheumatoid arthritis. This approach permits the preservation of the anterior C1 arch and the avoidance of a posterior fixation, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development.

Authors+Show Affiliations

Department of Neurosurgery, Umberto I University General Hospital, Università Politecnica delle Marche, Ancona, Italy. neurotra@tiscali.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23453575

Citation

Iacoangeli, Maurizio, et al. "Endoscopic Endonasal Odontoidectomy With Anterior C1 Arch Preservation in Elderly Patients Affected By Rheumatoid Arthritis." The Spine Journal : Official Journal of the North American Spine Society, vol. 13, no. 5, 2013, pp. 542-8.
Iacoangeli M, Gladi M, Alvaro L, et al. Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis. Spine J. 2013;13(5):542-8.
Iacoangeli, M., Gladi, M., Alvaro, L., Di Rienzo, A., Specchia, N., & Scerrati, M. (2013). Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis. The Spine Journal : Official Journal of the North American Spine Society, 13(5), 542-8. https://doi.org/10.1016/j.spinee.2013.01.043
Iacoangeli M, et al. Endoscopic Endonasal Odontoidectomy With Anterior C1 Arch Preservation in Elderly Patients Affected By Rheumatoid Arthritis. Spine J. 2013;13(5):542-8. PubMed PMID: 23453575.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis. AU - Iacoangeli,Maurizio, AU - Gladi,Maurizio, AU - Alvaro,Lorenzo, AU - Di Rienzo,Alessandro, AU - Specchia,Nicola, AU - Scerrati,Massimo, Y1 - 2013/03/01/ PY - 2012/01/07/received PY - 2012/09/27/revised PY - 2013/01/25/accepted PY - 2013/3/5/entrez PY - 2013/3/5/pubmed PY - 2013/12/24/medline SP - 542 EP - 8 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 13 IS - 5 N2 - BACKGROUND CONTEXT: Rheumatoid arthritis is the most common inflammatory disease involving the spine with predilection for the craniovertebral segment. Surgery is usually reserved to patients with symptomatic craniovertebral junction (CVJ) instability, basilar invagination, or upper spinal cord compression by rheumatoid pannus. Anterior approaches are indicated in cases of irreducible ventral bulbo-medullary compression. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA). PURPOSE: The aim of this article is to demonstrate the feasibility of performing an odontoidectomy and a rheumatoid pannus removal by a minimally invasive EEA, preserving the anterior C1 arch continuity and avoiding a posterior fixation procedure. STUDY DESIGN: Technical description and cohort report. METHODS: We report three cases of elderly patients with a long history of rheumatoid arthritis and irreducible anterior bulbo-medullary compression secondary to basilar invagination and/or rheumatoid pannus. Anterior decompression was achieved by an endonasal image-guided fully endoscopic approach. RESULTS: Neurological improvement and adequate bulbo-medullary decompression were obtained in all cases. The anterior C1 arch continuity was preserved, and none of the patients required a subsequent posterior fixation. CONCLUSIONS: Anterior decompression by a minimally invasive EEA could represent an innovative option for the treatment of irreducible ventral CVJ lesions in elderly patients with rheumatoid arthritis. This approach permits the preservation of the anterior C1 arch and the avoidance of a posterior fixation, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/23453575/Endoscopic_endonasal_odontoidectomy_with_anterior_C1_arch_preservation_in_elderly_patients_affected_by_rheumatoid_arthritis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(13)00120-4 DB - PRIME DP - Unbound Medicine ER -