Transoral odontoidectomy: our experience in a limited resources set-up
EANS Academy. Ullah S. 09/27/19; 276014; EP02132
Dr. Sajjad Ullah
Dr. Sajjad Ullah

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Background: For most of the pathologies due odontoid compression, decompression with odontoidectomy is the reasonable solution that usually relieve the symptoms. Transoral approach have been standard for odontoidectomy procedures. We share our experience of 13 cases done without use of navigation systems.
Methods: This study was conducted at the Neurosurgery departments HMC & LRH Peshawar from Jan 2017 to December 2018. All patients with basilar invagination compressing the cord from anterior were included while all redo cases, patients with associated pathology and compression due to posterior pathology were excluded. Patients were assessed clinically for axial neck pain and radicular symptoms using Nurick Score. Radiological evaluation included static and dynamic x-ray, CT scans and MRI of the craniocervical junction. Pre- and post op evaluation and Visual analog scale (VAS) score was documented for all the patients along with per-op complications.
Results: 13 consecutive cases of odontoid pathologies were included. There were 8 male and 5 female patients. Age range was 7-46 years with mean age 12 + 2.1 years. Tracheostomy was done in the first 4 cases only. 4 cases were done as staged procedure. Per-op complications include Vertebral artery mild laceration in one case only which was controlled with conservative management. Post op complications include breathing difficulty in 1 case but managed conservatively. Surgical site infection and implant failure was reported in one case. 1 patient, in whom tracheostomy was done, died due to hospital acquired Pneumonia. Minimum follow up was one month with average up to 1 ± 1.2 months. Mean preoperative Nurick scale was 1.1 ± 1.3. Mean postoperative Nurick scale was 0.6 ± 0.51. Mean VAS preoperative 7.1 ± 2.2 SD, mean postoperative VAS was 2.9 ± 0.5SD, and radicular symptoms were significantly improved in 91.6 % patients.
Conclusion: Transoral odontoidectomy followed by posterior fusion is safe, effective and feasible solution for odontoid pathologies with favorable post-operative outcome.
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