A posterolateral approach to XXXX : a report of the long-term follow-up of 23 cases.

@entity1 @entity75 @entity1457 @entity16 @entity600 @entity5173 @entity86 @entity130
STUDY DESIGN: A retrospective study of consecutive @entity1 series. OBJECTIVES: To report a technique of odontoidectomy using a transoccipitocervical posterolateral approach for @entity75 in a long-term follow-up study. SUMMARY OF BACKGROUND DATA: @entity600 and old @entity130 usually cause compression of the high cervical spinal cord from a variety of different directions and angles, leading to high morbidity. The main objective of treatment is to relieve the anteroposterior compression and to restore the stability of the occipitocervical region. Currently, there are 2 approaches to perform the surgical procedure: (1) posterior decompression by suboccipital and occipitocervical fusion and internal fixation; and (2) decompression by a transoral approach to an odontoid resection. However, there are some short points, which need to be changed, such as the incomplete decompression (the former), narrow view, @entity5173 , and the high infection rates. METHODS: From 1999 to 2006, 23 @entity1 with @entity75 were treated using a transoccipitocervical posterolateral approach for decompression. The procedure included an expansion of the foramen magnum, a resection of the posterior arch of atlas, a lateral occipitocervical epidural exposure to the odontoid and the C2 vertebra, and an excision of the odontoid. Thus, an anteroposterior decompression and occipitocervical spinal fusion was achieved. Neurological function, daily living ability, and the work ability of @entity1 were assessed in a follow-up study. RESULTS: A 28-year-old @entity1 died of respiratory and @entity1457 10 hours after operation. The remaining @entity1 survived without @entity86 . The @entity16 in 17 @entity1 did not deteriorate, whereas 5 @entity1 had decreased sensation in the upper limbs, and the elbow flexor muscle strength in 2 @entity1 declined by 1 grade on the operation side. Short-term follow-up (3-6 mo, 22 cases) indicated that 19 @entity1 recovered normal sensation with decreased limb muscle tension. Motor function was improved by >1 grade (5 @entity1 with @entity86 recovered to preoperative levels or better). Long-term follow-up (>4 y) of 15 @entity1 (10 @entity1 by clinic visit and 5 @entity1 by correspondence) indicated that the occipitoatlantoaxial regions were stable without local discomfort or loss of nerve function. Fourteen @entity1 were able to care for themselves and some @entity1 regained their ability to work. One @entity1 felt no significant improvement after surgery and had no improvement in the quality of life. CONCLUSIONS: Transoccipitocervical posterolateral approach to @entity75 provides a broad and sterile operating field to perform anteroposterior decompression and occipitocervical spinal fusion simultaneously. Neurological improvement is significant, and the long-term follow-up results are satisfactory.
