Total Spondylectomy of C2 and Circumferential Reconstruction via Combined Anterior and Posterior Approach to Cervical Spine for Axis Tumor Surgery

As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra （C2） surgery had been described previously in diverse approaches and reconstruction forms, each has its own limita- tions and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior （retropharyngeal） cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight con- secutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mor- tality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids （one of them experienced dysphonia） and 1 developed cerebrospinal fluid leakage （CSFL） that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale （VAS） and Japanese orthopedic association （JOA） score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixa- tion failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior re- construction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.

Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review

BACKGROUND Cervical spondylectomy for the treatment of cervical tumors is traumatic,causes bleeding,and is risky.This study reports on the experience with minimally invasive cervical spondylectomy for a cervical metastasis and reviewed the literature on cervical spondylectomy.The purpose was to reduce the risk and trauma of spondylectomy.CASE SUMMARY A 60-year-old woman presented with cervical pain and radiating pain in the left upper limb for more than 2 mo.Preoperative diagnosis was C4 metastasis of thyroid cancer.Preoperative visual analogue scale score was 5.American Spinal Cord Injury Association(ASIA)grade was E.Tomita classification was 7.Weinstein-Boriani-Biagini(WBB)classification was A-D,3-9.Tomita score was 5.Modified Tokuhashi score was 9.Spinal instability neoplastic score(SINS)was 13.The patient underwent minimally invasive cervical spondylectomy on September 28,2017.The operative time was 200 min;the estimated blood loss was 1200 mL.The operation was successful,without complications.The postoperative visual analogue scale score was 0.The patient remained classified as ASIA grade E at the last follow-up.She accepted regular iodine-131 therapy postoperatively.The serum thyroglobulin(Tg)level of this patient was 299.02 ng/mL at 1 mo after the operation and was 13.57 ng/mL at the last follow-up.There was no local recurrence at the 25-mo follow-up,according to images,single-photon emission computed tomography,and serum Tg levels.Obvious ossification and solid fusion of C3-C5 were found at the last follow-up.CONCLUSION Minimally invasive cervical spondylectomy with tubular retractor could minimize soft tissue trauma,intraoperative traction injury,and paraspinal muscle injury,accelerating postoperative recovery.This technique requires a rich experience in cervical spine surgery with tubular retractors,so that surgeons can visualize the anatomical structure in a small field.

Total En Bloc Spondylectomy for Lumbar Renal Cell Carcinoma and Review of the Literature

Introduction: Total en bloc spondylectomy (TES) is gaining increasing favour as a treatment of choice for cancers of the spine that are resistant to radiological and chemotherapeautic intervention such as renal cell carcinoma (RCC). Until recently, RCC of the lumbar spine has presented a surgical challenge due to anatomical and vascular constraints. The development of the combined posterior-anterior en bloc spondylectomy offers improved access to the lumbar region. This case report and review of the literature presents a combined posterior-anterior lumbar en bloc spondylectomy for RCC involving L3 vertebra, which we believe is the first reported in Australia. Methods: A 46-year-old male with a seven-year history of renal cell carcinoma resulting in a left nephrectomy presented with a lytic lesion involving the L3 vertebral body, extending to the epidural space and compressing the cauda equina and left L3 and L4 nerve roots on MRI. A literature review revealed ten previous cases of the posterior-anterior TES in the lumbar spine for cancerous lesions but none from Australia. Results: A posterior-anterior TES and L2-L4 fusion was performed to remove a cancerous renal cell carcinoma of L3 with wide margins. Blood loss was the major complication. The patient remains recurrence free at nineteen months post procedure. Conclusion: Despite being an aggressive and invasive procedure, TES is rapidly becoming the treatment of choice for curative and palliative care in select patients with isolated metastatic tumours of the lumbar spine.

Modified surgical techniques in total en bloc spondylectomy for thoracic and lumbar tumors with a single posterior approach

Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified

Thoracic giant cell tumor after two total en bloc spondylectomies including one emergency surgery:A case report

BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy(TES).Despite tumor recurrence,three-level TES was repeated after denosumab therapy.CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor.After emergency TES,the patient's spinal cord function recovered,and permanent paralysis was avoided.The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT.Unfortunately,the tumor recurred 9 months after the first surgery.After 12 months of denosumab therapy,the tumor size was reduced,and tumor calcification.To prevent recurrent tumor progression and provide a possible cure,a three-level TES was performed again.The patient returned to an active lifestyle 1 month after the second surgery,and no recurrence of GCT was found at the last follow-up.CONCLUSION This patient with acute paraplegia underwent TES twice,including once in an emergency,and achieved good therapeutic results.TES in emergency surgery is feasible and safe when conditions permit;however,it may increase the risk of tumor recurrence.