Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage
Anterior epidural abscess of the superior cervical cord with odontoid osteomyelitis is a rare but potentially devastating condition due to the potential for severe and irreversible neurological injury. Early and aggressive neurosurgical intervention and medical management is usually indicated in cas...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-12-01
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| Series: | Interdisciplinary Neurosurgery |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751917301639 |
| _version_ | 1818131593325182976 |
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| author | Orel A. Zaninovich, BS Nikolay L. Martirosyan, MD, PhD Wyatt L. Ramey, MD Travis M. Dumont, MD |
| author_facet | Orel A. Zaninovich, BS Nikolay L. Martirosyan, MD, PhD Wyatt L. Ramey, MD Travis M. Dumont, MD |
| author_sort | Orel A. Zaninovich, BS |
| collection | DOAJ |
| description | Anterior epidural abscess of the superior cervical cord with odontoid osteomyelitis is a rare but potentially devastating condition due to the potential for severe and irreversible neurological injury. Early and aggressive neurosurgical intervention and medical management is usually indicated in cases with symptomatic spinal cord compression and may be associated with superior clinical outcomes. Access to the craniovertebral junction for decompression of the upper cervical cord is complicated by the proximity of critical anatomical structures. The transoral approach is considered to be the standard for treating lesions of the odontoid and anterior epidural space of the superior cervical spine. The use of a tubular retractor for procedures of the craniovertebral junction has been described for several approaches to this region but its use has yet to be described for the transoral approach in a live patient. This report describes the novel use of a tubular retractor for cervicomedullary decompression via transoral odontoidectomy for abscess drainage and phlegmon resection in a patient with progressive cervical myelopathy. The tubular retractor serves to retract the pharyngeal wall flaps and expose the anterior arch of C1, odontoid, and inferior clivus. This variation of the transoral approach eliminates the need for stay sutures for these purposes and may be used for lesions of the odontoid and anterior epidural space of the superior cervical spine. Keywords: Odontoidectomy, Odontoid osteomyelitis, Tubular retractor, Transoral, Epidural abscess, Spine |
| first_indexed | 2024-12-11T08:23:24Z |
| format | Article |
| id | doaj.art-a5a80d11ffb24dfc900279dd354ebf79 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-11T08:23:24Z |
| publishDate | 2017-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-a5a80d11ffb24dfc900279dd354ebf792022-12-22T01:14:37ZengElsevierInterdisciplinary Neurosurgery2214-75192017-12-011096100Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainageOrel A. Zaninovich, BS0Nikolay L. Martirosyan, MD, PhD1Wyatt L. Ramey, MD2Travis M. Dumont, MD3Corresponding author.; Division of Neurosurgery, Banner University Medical Center, 1501 N Campbell Avenue Room 4303, 85724 Tucson, AZ, USADivision of Neurosurgery, Banner University Medical Center, 1501 N Campbell Avenue Room 4303, 85724 Tucson, AZ, USADivision of Neurosurgery, Banner University Medical Center, 1501 N Campbell Avenue Room 4303, 85724 Tucson, AZ, USADivision of Neurosurgery, Banner University Medical Center, 1501 N Campbell Avenue Room 4303, 85724 Tucson, AZ, USAAnterior epidural abscess of the superior cervical cord with odontoid osteomyelitis is a rare but potentially devastating condition due to the potential for severe and irreversible neurological injury. Early and aggressive neurosurgical intervention and medical management is usually indicated in cases with symptomatic spinal cord compression and may be associated with superior clinical outcomes. Access to the craniovertebral junction for decompression of the upper cervical cord is complicated by the proximity of critical anatomical structures. The transoral approach is considered to be the standard for treating lesions of the odontoid and anterior epidural space of the superior cervical spine. The use of a tubular retractor for procedures of the craniovertebral junction has been described for several approaches to this region but its use has yet to be described for the transoral approach in a live patient. This report describes the novel use of a tubular retractor for cervicomedullary decompression via transoral odontoidectomy for abscess drainage and phlegmon resection in a patient with progressive cervical myelopathy. The tubular retractor serves to retract the pharyngeal wall flaps and expose the anterior arch of C1, odontoid, and inferior clivus. This variation of the transoral approach eliminates the need for stay sutures for these purposes and may be used for lesions of the odontoid and anterior epidural space of the superior cervical spine. Keywords: Odontoidectomy, Odontoid osteomyelitis, Tubular retractor, Transoral, Epidural abscess, Spinehttp://www.sciencedirect.com/science/article/pii/S2214751917301639 |
| spellingShingle | Orel A. Zaninovich, BS Nikolay L. Martirosyan, MD, PhD Wyatt L. Ramey, MD Travis M. Dumont, MD Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage Interdisciplinary Neurosurgery |
| title | Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage |
| title_full | Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage |
| title_fullStr | Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage |
| title_full_unstemmed | Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage |
| title_short | Use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage |
| title_sort | use of a tubular retractor for transoral odontoidectomy of upper cervical epidural phlegmon extraction and abscess drainage |
| url | http://www.sciencedirect.com/science/article/pii/S2214751917301639 |
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