Endoscopic Transnasal Odontoidectomy: A Novel Technique in Orthopedic Surgery

Abstract

Over the past decade, a minimally invasive technique to address upper cervical spine pathology has been executed successfully within ENT and neurosurgical communities. One indication for this endoscopic transnasal surgery is to remove the odontoid process of C2. We aim to provide a detailed description of the current state of endoscopic endonasal odontoidectomy (ETO) techniques through a systematic literature review. We also report the clinical course of a patient who underwent an ETO with involvement of an orthopedic spinal surgeon. It is our hope that by highlighting the feasibility and positive outcomes of this approach, it may propagate more broadly through the spine community. A 61-year-old male presented to clinic with complaints of neck pain that radiated into the right arm. He had a remote history of closed head injury as a professional boxer, as well as previous ACDF from C4 to C7. On exam, the patient was myelopathic with diffuse 4/5 weakness in all extremities. Imaging revealed a Type-1 odontoid fracture non-union and significant stenosis at the C1 level, with only 7.7 mm available for the cord. After conferring with an interdisciplinary team, the patient was indicated for C1 laminectomy with posterior spinal fusion of C1–C2 and endoscopic transnasal odontoidectomy. At 5-month follow-up, the patient has reported improved gait mechanics, absence of RUE paresthesias, and improved RUE strength. ETO is a viable, safe alternative to previously used methods of odontoid resection. As familiarity with the procedure increases throughout the medical field, further research should determine the most effective methods of ameliorating known complications.