Kalanchiam Guna Pratheep, Robin Pillay, Yann Lim Ming, Oh Jacob Yoong Leong
Spine Surgery Unit, Department of Orthopedics, Tan Tock Seng Hospital, Singapore.
Department of Neurosurgery, National Neuroscience Institute, Singapore.
J Orthop Case Rep. 2025 Jan;15(1):109-115. doi: 10.13107/jocr.2025.v15.i01.5144.
Surgeries in the occipitocervical and upper cervical region are always quite challenging and need adequate surgical experience and expertise. Especially in cases, where both anterior and posterior surgical access is required, complication rates could be significantly high. The transoral approach for the ventral pathologies of the upper cervical region has been previously described using the conventional open technique where post-operative morbidity is a concern. Moreover, problems such as dysphagia, risk of injury to the oral components, and surgical site infection are always an issue. In patients requiring a combined posterior approach, surgical morbidity, and post-operative recovery is always an area of concern. We describe a case report of upper cervical myelopathy managed under full navigation using a combined tubular transoral (minimally invasive) and posterior approach.
A 74-year-old male patient presented with myelopathy and weakness in bilateral upper and lower limbs (MRC Grade 4/5) due to a cystic lesion at C1 causing ventral cord compression. A staged anterior (minimally invasive transoral tubular approach) - posterior procedure was performed under full navigation for decompression and stabilization of C1-C2. Postoperatively, the patient showed neurological improvement (MRC Grade 5/5) in all four limbs.
A 360° navigation-guided approach to the upper cervical spine is a safer and more effective procedure with less risk of neurological and vascular complications. Furthermore, combining minimally invasive access anteriorly to the odontoid ensures reduced surgical morbidity of the overall procedure.
枕颈和上颈椎区域的手术一直颇具挑战性，需要足够的手术经验和专业技能。特别是在需要前后路手术入路的情况下，并发症发生率可能会显著升高。先前已描述过上颈椎腹侧病变的经口入路，采用传统开放技术，术后发病率是一个令人担忧的问题。此外，吞咽困难、口腔结构损伤风险和手术部位感染等问题一直存在。在需要联合后路手术的患者中，手术发病率和术后恢复始终是一个令人关注的领域。我们报告一例采用联合管状经口（微创）和后路入路在全导航下治疗上颈椎脊髓病的病例。
一名74岁男性患者因C1处囊性病变导致腹侧脊髓受压，出现脊髓病及双侧上下肢无力（医学研究委员会肌力分级4/5级）。在全导航下分阶段进行前路（微创经口管状入路）-后路手术，以解除C1-C2压迫并实现稳定。术后，患者四肢神经功能均有改善（医学研究委员会肌力分级5/5级）。
对上颈椎采用360°导航引导入路是一种更安全、有效的手术方法，神经和血管并发症风险更低。此外，前路对齿状突采用微创入路可降低整个手术的发病率。
