Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

Abstract

Purpose: This review aimed to describe the preoperative management and postoperative complications associated with transoral decompression of the upper cervical spine, and to clarify the risk factors, related issues and complication management.

Methods: Studies on transoral decompression for the upper cervical spine were reviewed systematically. The preoperative management and postoperative complications associated with transoral decompression for upper cervical deformities were analyzed.

Results: Evidence suggests that preoperative management in patients undergoing transoral decompression for the upper cervical spine is closely related to the occurrence of postoperative complications. Hence, preoperative surgical planning, preoperative preparation, and oral nursing care should be seriously considered in these patients. Moreover, while being established as an effective and safe method, transoral decompression is associated with several postoperative complications, which could be prevented by elaborate preoperative management, improved surgical skills, and appropriate precautionary measures.

Conclusions: The effectiveness and safety of transoral decompression has been improved by the constant development of operative techniques and advanced auxiliary diagnostic and therapeutic methods, with the understanding of the anatomical structure of the craniocervical joint. Therefore, the incidence rates of postoperative complications have decreased. The application of individualized anterior implants and less-invasive endoscopic endonasal approach has improved the effectiveness of transoral decompression and reduced the associated complications.

Keywords: Complications; Preoperative management; Transoral decompression; Upper cervical spine.

Fig. 1

The preoperative management and the postoperative complications of transoral approach for the upper cervical deformities. Oral nursing care helps to reduce the occurrence of oropharyngeal complications, oral wound infection and dehiscence, as well as the occurrence of systemic complications such as pneumonia. Preoperative surgical planning and preoperative preparation play a role in reducing the occurrence of other complications

Fig. 2

A 55-year-old woman presented with numbness and weakness of limbs and was diagnosis with basilar invagination. A and B: Preoperative sagittal T1-weighted and T2-weighted MR images show intraspinal tumor in the upper cervical spine. C and D: Preoperative sagittal CT scan and CT angiography of the upper cervical spine. E: Intraoperative fluoroscopy with locating pin. F: Intraoperative tumor exposure after spinal durotomy. G: Duraplasty after tumor excision. H: Posterior fusion and stabilization. I and J: Postoperative sagittal T1-weighted and T2-weighted MR images show that intraspinal tumor was resected and the spinal cord was sufficient decompressed. K and L: Sagittal T1-weighted and T2-weighted MR images at a follow-up of 3 months postoperatively and the patient could walk well after the operation