Tubular-retractor-assisted transoral decompression for ventral compression of cranio cervical junction

The transoral approach is well established for ventral decompression of the CVJ. However, complications associated with traditional transoral access make many surgeons shy away from it. We investigate the use of tubular retractors to provide access to the CVJ while sparing the soft palate with the aim of reducing complications associated with the traditional transoral approach but yet allowing adequate decompression of the CVJ.

Methods:
Eleven consecutive patients with severe myelopathy from ventral CVJ compression were operated between 2015-2020 using tubular-retractor-assisted transoral decompression.

Results:
All patients improved neurologically. The complications associated with splitting soft palate were completely avoided. There was one case with incomplete removal of the lateral wall of odontoid and incidental durotomy during removal of OPLL.

Conclusion:
Tubular retractors provide adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushes away the uvula, soft palate, and pillars of the tonsils as it docks on the posterior pharyngeal wall, the usual complications associated with traditional transoral procedures are completely avoided.