C2 lamina reconstruction using locking miniplate for the intradural tumor of the craniocervical junction (two case reports)

Abstract

Objective To describe a technique for C2 lamina reconstruction using locking miniplates for the extirpation of spinal tumors in the craniocervical junction. Summary of background data Many spinal surgery cases in which lamina reconstructions have been performed using non-locking miniplates have been reported. However, there is only one report of the use of locking miniplates for lamina reconstruction in spinal tumor cases. Methods We performed C2 lamina reconstructions using locking miniplates in a patient with a spinal tumor and another with a cystic lesion. The clinical and radiologic features of both cases are reported, and the surgical technique is described. Results A 62-year-old female and a 30-year-old male were diagnosed with meningioma and a neurenteric cyst, respectively, in the craniocervical junction. Extirpation of these lesions was performed in combination with C2 lamina reconstruction and reattachment of the paraspinous muscle to the C2 spinous process. A follow-up examination at 1 year postoperatively demonstrated no significant change in the sagittal alignment of the cervical spine and a good postoperative course in both cases. Bony fusion was detected in both cases, and no implant failure occurred in either case. Conclusions This procedure results in rigid fixation of the reimplanted C2 lamina and helps to restore the paraspinous muscles. For these reasons, it appears to be a useful surgical procedure for spinal tumors requiring C2 laminectomy and does not cause postoperative kyphosis of the cervical spine.

A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety

“…1-4,6-11 The placement of titanium plates not only maintains the relative integrity of the spinal canal, but also substantially increases the immediate stability of the cervical vertebrae. 4,7,8 However, during laminoplasty, trimming or excision of spinous processes will damage the supraspinous ligament/interspinous ligament complex and eliminate effective attachment points for posterior extensor muscles, leading to muscle atrophy and even development of cervical kyphosis. 12,13 The MLC, consisting of supraspinous ligaments, interspinous ligaments, and muscles attached to the spinous process, is an important source of stability for the cervical vertebrae, and critical for the maintenance of mechanical balance and spinal curvature.…”

Minimally invasive approach for small ventrally located intradural lesions of the craniovertebral junction

“…7 Martin et al 10 described a posterolateral approach for vascular malformations and tumors of the ventrolateral aspect of the spinal cord. They proposed a slight rotation of the spinal cord after multilevel division of the dentate ligament cranial and caudal to the lesion, which in our opinion is not possible at the CVJ level because this is where the brainstem begins.…”

“…Furthermore, artifacts caused by metal implants have to be expected and may impair imaging at follow-up. 7 Limitations of this minimally invasive approach are the limited space for manipulation and the restricted view. However, because of the widespread distribution of tubular systems, more and more surgeons can get used to this kind of approach.…”

“…In contrast, minimally invasive approaches to small ventral lesions at the upper cervical spine and CVJ have rarely been reported. 4,5,7 Here, we report a surgical technique for accessing small intradural lesions located ventral to the neuraxis at the CVJ. By using a minimally invasive dorsal approach between the occiput (C-0) and C-1 or C-1 and C-2, complete removal of ventrolateral lesions can be achieved while avoiding bone removal and extensive muscular mobilization.…”

Occipito-cervical fusion following gross total resection for the treatment of spinal extramedullary tumors in craniocervical junction: a retrospective case series

“…In some cases, the posterior arch and facet joint of the C1 vertebra need be removed (C1 laminectomy and facetectomy) before extirpation from the craniocervical extramedullary tumor. Unfortunately, a limited laminectomy and facetectomy for resection of spinal cord tumors has been strongly associated with postoperative upper cervical instability or deformity [ 7 – 9 ]. For these reasons, reconstruction of upper cervical stability is considered to be important for preventing postoperative deformity after the resection of spinal extramedullary tumors.…”