Transoral Transmandibular Approach for Multilevel Anterior Cervical Fusion: Technical Note

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• The transoral transmandibular approach is utilized for C1-3 pathologies requiring anterior or combined anteroposterior surgical access.
• Previous applications include cervical tumors, deformities, and fractures from rheumatological conditions.

Purpose of the Study:

• To illustrate the utility of the transoral transmandibular approach in managing cervical osteomyelitis.
• To present a case of multilevel cervical osteomyelitis with pathological fractures treated with this approach.

Main Methods:

• A 29-year-old male with C1-4 osteomyelitis and C2-3 pathological fractures underwent initial posterior fusion.
• Due to pseudoarthrosis and posterior element erosion, an anterior transoral transmandibular approach was performed for C2-4 corpectomies and anterior fusion.
• Subsequent posterior occiput-C6 fusion was completed.

Main Results:

• The anterior transoral transmandibular approach provided necessary access for corpectomies and anterior column reconstruction.
• Postoperative outcomes included a stable neurological exam and reduced neck pain.
• The surgical strategy successfully managed the complex cervical pathology.

Conclusions:

• The transoral transmandibular approach is a valuable technique for pathologies affecting the C1-3 cervical spine.
• It enables effective anterior access for multilevel corpectomies and reconstruction.
• This approach is crucial for treating complex conditions like cervical osteomyelitis with instability.