颈椎脊索瘤的临床特点及外科治疗

Clinical character and surgical interventions of chordomas in the cervical spine

目的探讨颈椎脊索瘤的临床特点及外科治疗方法与疗效。方法对1989年至2006年接受手术治疗的8例颈椎脊索瘤患者的临床资料进行回顾性分析。男5例,女3例;年龄34～72岁,平均53.8岁。依据肿瘤的WBB分期,实施次全或全椎体切除术3例,矢状切除术2例,次全或全脊椎切除术2例,颈椎管内脊索瘤囊外摘除术1例。脊柱稳定性重建术中,取自体髂骨植骨5例,钛网内骨水泥填塞前路椎体支撑2例。术后行辅助放疗。结果患者术后神经根性刺激症状较术前明显缓解或消失,颈髓压迫症状多有1～2个级别以上的改善。术后病理检查均可见典型“Physaliphorous细胞”。随访3～120个月,平均43.5个月。内固定物融合良好,植骨融合率100%。肿瘤局部复发4例,1例死于肿瘤复发后的高位截瘫并发症,全脊椎切除者未见复发迹象。7例未见远处转移,1例颈椎管内脊索瘤者既往有骶骨脊索瘤手术史,故考虑为原发骶骨脊索瘤继发硬膜下转移。结论颈椎脊索瘤临床相对少见,早期症状不典型,诊断应重视CT和MR检查。全脊椎切除术结合术后局部放疗可降低局部复发率。

Objective To retrospectively study the character, surgical interventions of chordomas in the cervical spine. Methods All the clinical data of 8 cases of chordoma arising in the cervical spine which under went surgical treatment in our department from 1989 to 2006 were retrospectively reviewed, which including 5 males and 3 females. The patients ranged from 34 to 72 years at diagnosis, with an average age of 53.8 years. Surgical interventions were defined according to WBB criteria. 3 patients underwent subtotal centrum or total centrum resection, 2 patients underwent sagital resection and 2 patients received subtotal or total spondylectomy. Extracapsular excision was performed in a intradural invasion case. Autogenic iliac blocks were used as bone graft in 5 cases and titanium mesh with bone cement filling-in for anterior pedestal in 2 cases for reconstructing the stability of spine. Radiation therapy was given as an adjuvant treatment after surgery. Results Symptom of nerve root irritation disappeared or relieved prominently and the patients suffering spinal cord compression symptom got well recovery with at least 1 or 2 levels after operation. The typical ＂Physaliphorous cell＂ could be found in the oncologic examination in all those cases. Follow-up average 43.5 months, ranged from 3 to 120 months. All the internal fixation got well fusion and the rate of fusion for the bone graft was 100%. There were 4 cases in which the postoperative local recurrence of the tumor can be seen, with one patient dead of complications of high paralysis, but no local recurrence was observed in the cases which received total spondylectomy. No evidence of distant metastasis was observed in 7 cases for our series except the special intradural case which had the operation history for ＂sacral chordoma＂ before. So we consider it as a intradural metastasis case of the primary sacral chordoma. Conclusion Chordomas are rarely seen in the cervical spine and the typical clinical manifestation is rare in pristine cases. So we should think highly of the CT and MR examination for diagnosis. Total spondylectomy with postoperative radiation therapy could lower the rate of local recurrence.