Posterior extradural transpedicular monolateral odontoidectomy (PETMO): a technical note.

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Craniovertebral junction (CVJ) instability with irreducible basilar invagination (BI) presents significant surgical challenges.
• Standard anterior decompression techniques carry notable morbidity.
• Posterior approaches for CVJ pathology are often invasive.

Purpose of the Study:

• To report the first clinical use of a purely posterior, extradural, transpedicular, monolateral odontoidectomy (PETMO) as a novel surgical alternative.
• To evaluate the efficacy and safety of PETMO in a patient with irreducible BI and os odontoideum.

Main Methods:

• A 67-year-old woman with progressive myelopathy underwent PETMO with occipitocervical fixation.
• Odontoid and os odontoideum were resected en bloc via a right C2 transpedicular corridor using an ultrasonic bone dissector.
• Intraoperative neurophysiological monitoring and micro-Doppler were employed.

Main Results:

• The patient demonstrated steady neurological improvement, regaining independent ambulation at 1-year follow-up.
• Postoperative imaging confirmed complete resection and effective cervicomedullary decompression.
• CVJ realignment was achieved with successful decompression.

Conclusions:

• PETMO is a feasible posterior alternative for anterior CVJ decompression in selected patients with irreducible pathology.
• This technique avoids the aerodigestive tract and minimizes neural and vascular manipulation.
• PETMO expands surgical options for CVJ management and warrants further investigation.