MIS transoral technique for C1-C2 cord compression - Intricacies using a 360⁰ navigated approach.

Introduction: Surgeries in the occipitocervical and upper cervical region are always quite challenging and need adequate surgical experience and expertise. Especially in cases, where both anterior and posterior surgical access is required, complication rates could be significantly high. The transoral approach for the ventral pathologies of the upper cervical region has been previously described using the conventional open technique where post-operative morbidity is a concern. Moreover, problems such as dysphagia, risk of injury to the oral components, and surgical site infection are always an issue. In patients requiring a combined posterior approach, surgical morbidity, and post-operative recovery is always an area of concern. We describe a case report of upper cervical myelopathy managed under full navigation using a combined tubular transoral (minimally invasive) and posterior approach.

Case report: A 74-year-old male patient presented with myelopathy and weakness in bilateral upper and lower limbs (MRC Grade 4/5) due to a cystic lesion at C1 causing ventral cord compression. A staged anterior (minimally invasive transoral tubular approach) - posterior procedure was performed under full navigation for decompression and stabilization of C1-C2. Postoperatively, the patient showed neurological improvement (MRC Grade 5/5) in all four limbs.

Conclusion: A 360° navigation-guided approach to the upper cervical spine is a safer and more effective procedure with less risk of neurological and vascular complications. Furthermore, combining minimally invasive access anteriorly to the odontoid ensures reduced surgical morbidity of the overall procedure.