Anterior Transoral Odontoid Reduction With Clivocervical Fusion in Revision Surgery for Craniovertebral Junction Anomalies: A Case Report and Technical Note.

BACKGROUND

Craniovertebral junction anomalies (CVJAs), including conditions such as basilar invagination and atlantoaxial dislocation, frequently result in progressive neurological deterioration. Traditional surgical approaches-whether anterior, posterior, or combined-may prove inadequate for revision cases characterized by persistent ventral compression. This study evaluates the efficacy of anterior transoral odontoid reduction combined with clivocervical fusion for managing complex CVJAs requiring revision surgery.

METHODS

A 56-year-old female patient presented with recurrent symptoms following prior posterior occipitocervical fusion. She underwent revision surgery involving anterior transoral odontoid reduction combined with clivocervical fusion. Postoperative rehabilitation, imaging studies (CT, MRI, and CTA), and neurological function assessed via the JOA score were evaluated at 3-, 6-, and 12-month follow-up intervals.

RESULTS

Postoperative imaging demonstrated significant improvements: the clivo-axial angle improved to 146.1° from 135.5°, the odontoid tip descended caudally by 4.33 mm, and spinal cord compression resolved. Neurological function improved, with stable fixation, successful fusion, and no complications. Long-term follow-up confirmed sustained radiographic stability and neurological recovery.

CONCLUSION

Anterior transoral odontoid reduction combined with clivocervical fusion effectively addresses persistent ventral compression in revision CVJAs cases. This technique achieves neural decompression, biomechanical stability, and functional recovery, offering a promising option for complex cases with failed initial posterior fixation.