Surgical Outcome After Transoral Odontoidectomy and Occipitocervical Fusion for Basilar Impression

Barry D. Birch, MD
Gerald Radts, MD
Regis Haid, MD (Atlanta, GA)

Introduction:

The transoral–transpharyngeal approach to the upper cervical spine and clivus is well described. It is most commonly used to address cervicomedullary compression due to lesions and anomalies of the odontoid, such as rheumatoid pannus and basilar impression. In most cases, removal of the odontoid and its associated transverse and alar ligaments renders the occiptoatiantoaxial complex unstable. We report the surgical outcomes on I I patients with basilar impression and occipitocervical anomalies following transoral odontoidectomy and occipitocervical fusion using a titanium loop and sublaminar cables.

Methods:

Eleven patients (13 – 72 years old) with cervicomedullary compression due to basilar impression with congenital occipitocervical anomalies were evaluated by a retrospective review of charts and radiological studies. Demographics, presenting complaints, operative and postoperative courses, and pre– and postoperative imaging studies were assessed for each patient. Three patients had preoperative cervical traction with no reduction. The operative procedure is described. Patients were braced in a rigid cervical collar for three months after operation. Postoperative outcome measures included the Ranwat neurological classification and the ARA functional grading system, surgical complication rate, and fusion rate. Minimum follow up was 6 months (range 6 – 48 mos).

Results:

Patients improved and average of 1 Ranwat and 1 ARA level after surgery. There were no neurological deteriorations or deaths. Pseudoarthrosis occured in one patient without the need for reoperation. Complications included 2 cases of pneumonia and one patient with mild swallowing difficulty after resection of 3 mm of the hard palatte.

Conclusions:

Transoral decompression of the cervicomedullary junction followed by occiptocervical fusion using a titanium loop and cables is associatied with good neurological outcome and acceptable complication rates for patients with basilar impression and occipitocervical anomalies. The fusion rate is excellent without halo immobilization.