Ruetten Sebastian, Hahn Patrick, Oezdemir Semih, Baraliakos Xenophon, Godolias Georgios, Komp Martin
a Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group , Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne, University Hospital of the Ruhr University of Bochum/Marien Hospital Witten , Herne , Germany.
b Center for Rheumatology, Rheumazentrum Ruhrgebiet , Ruhr University of Bochum , Herne , Germany.
Minim Invasive Ther Allied Technol. 2019 Jun;28(3):178-185. doi: 10.1080/13645706.2018.1498357. Epub 2018 Sep 4.
Infections of the anterior craniocervical junction may require surgery. There are various techniques with individual advantages and disadvantages. This study evaluates the full-endoscopic uniportal technique via the anterior retropharyngeal approach for odontoidectomy, decompression, and debridement.
Three patients with an infection of the anterior craniocervical junction with retrodental involvement were operated on between 2014 and 2016 using the full-endoscopic uniportal technique. Posterior stabilization was also performed with the same procedure for all patients.
The operation was technically satisfactory in all cases. No problems due to swelling of the pharyngeal soft tissue occurred. No other complications were observed. All patients had a satisfactory outcome with stable regression of the myelopathy symptoms and/or complete healing of the infection. The follow-up images showed sufficient decompression of bone and soft tissues in all cases.
The full-endoscopic uniportal technique with an anterior retropharyngeal approach can be an adequate and minimally invasive surgical technique for odontoidectomy, decompression, and debridement in infections of the craniocervical junction and can reduce access-related problems. The transoral, transnasal, and retropharyngeal approaches have different surgical fields due to the access trajectories, which must be taken into consideration depending on the anatomy and pathology when selecting a suitable technique.
前颅颈交界区感染可能需要手术治疗。有多种手术技术，各有优缺点。本研究评估经咽后前路的全内镜单孔技术用于齿状突切除、减压和清创。
2014年至2016年间，对3例累及齿状突后方的前颅颈交界区感染患者采用全内镜单孔技术进行手术。所有患者均采用相同手术步骤进行后路固定。
所有病例手术技术上均令人满意。未出现因咽软组织肿胀导致的问题。未观察到其他并发症。所有患者预后良好，脊髓病症状稳定消退和/或感染完全愈合。随访影像显示所有病例均有充分的骨和软组织减压。
经咽后前路的全内镜单孔技术对于颅颈交界区感染的齿状突切除、减压和清创而言，可能是一种合适的微创外科技术，且可减少与入路相关的问题。经口、经鼻和经咽后入路因入路轨迹不同而有不同的手术视野，选择合适技术时必须根据解剖结构和病理情况予以考虑。
