Anterior endoscopically assisted transcervical reconstruction of the upper cervical spine

Anterior decompression and/or reconstruction can be an effective method for the surgical treatment of ventral spinal cord compression in the upper cervical spine. Options for traditional surgical approaches include transoral, transnasal, and extraoral. The risk and complex anatomy with the aforementioned approaches induces surgeons to use the transcervical route to expose the upper cervical spine. A traditional transcervical approach, however, carries the disadvantages of a deep operative field and steep trajectory. We performed a new endoscopically assisted method of anterior reconstruction for the treatment of ventral lesions in upper cervical spine. Six patients were treated from January 2005 to December 2007. Among those six patients, three patients were diagnosed with fixed atlantoaxial dislocations, two with plasmacytomas, and one with a giant cell tumor. All patients were treated by combined endoscopically assisted anterior reconstruction and posterior fusion. One patient with a fixed atlantoaxial dislocation sustained a cerebrospinal fluid leak in the immediate postoperative period, which spontaneously resolved 7 days after surgery. None of the patients had any neurologic deterioration following surgery, nor did any require admission to the intensive care unit for any reason. At the final follow-up, all patients were found to have evidence of a successful clinical outcomes and radiographic fusion. There were no implant failures or radiographic signs of implant migration or loosening. In conclusion, this study demonstrates that an anterior transcervical decompression using endoscopic visualization combined with a posterior arthodesis can achieve good clinical and radiographic outcomes.