Araneta Karla Teresa Saldaña, Bundoc Rafael
Department of Orthopedics, Philippine General Hospital, Manila, Metro Manila, Philippines
Department of Orthopedics, Philippine General Hospital, Section of Spine Surgery, University of the Philippines Manila, Manila, Metro Manila, Philippines.
BMJ Case Rep. 2021 Mar 2;14(3):e239240. doi: 10.1136/bcr-2020-239240.
The use of tubular retractors in minimally invasive spine surgery has been described extensively in the literature. However, there are only select reports discussing their use specifically in a transoral approach for upper cervical pathologies such as an epidural abscess and a dystrophic os odontoideum.We report the first use of a transtubular transoral approach in a rare case of an adult presenting with severe neck pain with progressing neurologic signs secondary to atlantoaxial Pott's disease. Debridement and partial odontoidectomy performed using this approach allowed less trauma to surrounding soft tissues without sacrificing an excellent visualisation of the operative field. A halo vest was applied to provide temporary stability. The patient transitioned out of his halo vest after 6 months while completing medical therapy after a year without need for further intervention. The transtubular transoral approach is a suitable alternative to the conventional approach in patients with atlantoaxial Pott's disease.
管状牵开器在微创脊柱手术中的应用已在文献中得到广泛描述。然而，仅有少数报告专门讨论了其在经口入路治疗上颈椎病变（如硬膜外脓肿和齿状突发育不良）中的应用。我们报告了首例经口经管状入路治疗一名成年患者的罕见病例，该患者因寰枢椎结核继发严重颈部疼痛并伴有进行性神经体征。使用该方法进行清创和部分齿状突切除术，对周围软组织的创伤较小，同时不影响术野的良好可视化。应用头环背心提供临时稳定性。患者在6个月后拆除头环背心，并在一年后完成药物治疗，无需进一步干预。经口经管状入路是治疗寰枢椎结核患者的传统方法的合适替代方案。
