Review of transoral odontoidectomy. Where do we stand? Technical note and a single-center experience

Background: Transoral odontoidectomy followed by occipitocervical fixation is an accepted technique for the treatment of ventral compression at the craniocervical junction (CVJ). It is thought that surgical experience has stagnated owing to both the development of endonasal approaches, and improvement in rheumatoid pharmaceutical therapies. Accurate knowledge on whether the declining experience affects rates of intra-operative and peri-operative complications is essential. Herein, we present an illustrated technical note and case series based on our 10-year surgical experience. Methods: Technical pearls for the transoral ondontoidectomy approach are discussed and illustrated. A retrospective analysis of patients aged 18 years or older who underwent the procedure over the last 10 years was conducted. Both intra and post-operative complications were recorded and compared to historical controls. Results: Ten patients were identified with an average of 60 years of age and follow-up time of 15 months. Indications for surgery included rheumatoid (10%), degenerative (30%) and pseudogout cervical pannus (10%), basilar invagination (30%), and malignancy (20%). Average length of stay was 19.4 days. Two patients suffered from intra-operative CSF leaks while 8 patients suffered from post-operative medical complications including the need for tracheostomy for 4 individuals. Rate of improved neurological outcomes was 60% while 20% of patients were stable at last clinic follow-up. Conclusion: In this study, we describe our technique to obtain exposure and perform decompression of CVJ ventral pathologies via the transoral route. The intra and post-operative complications we report represent the common pitfalls. Highly specialized and comprehensive patient care remains essential as post-operative complication rates remain high.