• Riaz Ur Rehman, Muhammad Shaheer Akhtar, Amna Bibi, Syed Mansoor Shah, Sohrab Khan, and Muhammad Kashif.
• Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan.
• World Neurosurg. 2022 Sep 1; 165: 274427-44.

BackgroundAlthough posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe degeneration and neural compression.MethodsConsecutive patients who underwent transoral odontoidectomy for basilar invagination and atlantoaxial dislocation at the neurosurgical unit of Lady Reading Hospital Peshawar between June 2016 and January 2022 were retrospectively included. Preoperative and postoperative neurological, clinical, and radiological parameters were recorded and compared.ResultsOf the 33 patients included in this study, 22 were men and 11 were women. The mean age was 23.4 years ±8.4 years (mean ± standard deviation). The most common presenting symptoms were gait abnormalities and neck pain. A total of 28 patients were treated for the first time, while 5 patients had prior posterior fusion. The mean distance of the tip of the dens above the chamberlain line was 8.9 ± 4.2 mm, while the mean anterior atlantodental interval was 6.5 ± 2.1 mm. Seven patients had an anomalous course of vertebral artery on at least one side. A total of 28 patients improved significantly, while 5 patients did not improve at the follow-up. The mean follow-up was 8.5 months ±6.3 (mean ± standard deviation). The mean Nurick and Modified Japanese Orthopedic Association scores improved postoperatively (P < 0.05). Three patients underwent reoperation including one with vertebral artery injury. Three patients underwent tracheostomy.ConclusionsWith proper patient selection, transoral odontoidectomy can be safely performed in a limited-resource setting.Copyright © 2022 Elsevier Inc. All rights reserved.

26 keywords...

hide…