Total Spondylectomy of C2

Štulík, J; Kozák, Jiří; Šebesta, P; Vyskočil, T; Kryl, J; Klézl, Zdeněk

doi:10.1097/bsd.0b013e3181d0c1e5

Cited by 25 publications

(22 citation statements)

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“…It has been shown that conducting the posterior operation first can reduce the risk of failure of column support and VA injury. [ 14 ] In the first case, we performed the posterior laminectomy first because this can enlarge the vertebral canal volume and increase the mobility of the cervical cord, thereby reducing the risk of spinal cord injury during the anterior operation. Although conducting the posterior surgery first can reduce the risk of implant migration and VA injury, it can make the anterior operation difficult, especially in the high cervical spine.…”

Section: Discussionmentioning

confidence: 99%

Total spondylectomy of recurrent giant cell tumors in the cervical spine

Shu

et al. 2018

Medicine

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Rationale:Spinal Giant Cell Tumors (SGCTs) are rare, aggressive, and benign tumors. Their presence in the cervical spine is even more exceptional. There are few reports of cervical GCT in the literature, especially recurrent cases. The treatment are challenging to clinically because radical resection is extremely difficult.Patient concerns:In this study, we present the cases of a 25-year-old man and a 41-year-old woman who suffered from recurrent cervical GCT.Interventions:They underwent extensive total spondylectomy of C3-5 and C2-4, respectively, by a combined anterior and posterior approach.Outcomes:Both patients had a satisfactory prognosis after 2 years followe-up, and extensive total spondylectomy provided good disease-free survival rates. Extensive total spondylectomy of cervical recurrent giant cell tumor was successfully achieved combined anterior and posterior approach.Lessons:This surgical technique can be an effective option for this pathological condition, which is difficult to manage using other conventional treatment options including repeated curettage and radiotherapy. However, there are insufficient data on long-term subjective outcomes in this type of patient, and larger series studies are needed to determine the efficacy of this approach, especially compared with piecemeal resection techniques.

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Section: Discussionmentioning

confidence: 99%

Total spondylectomy of recurrent giant cell tumors in the cervical spine

Shu

et al. 2018

Medicine

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“…Expected dysphagia and upper airway problems may lead to the need for gastrostomy, tracheostomy or both. 6 Furthermore, the anterior instrumentation is in close proximity to the pharynx. This is particularly concerning because retropharyngeal instrumentation carries the risk of hardware exposure in patients who receive radiation and/or are malnourished due to systemic disease and/or dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…Axial spondylectomy can be done with combined anterior and posterior incisions with preservation of all neurovascular structures, as advocated by some. 6,31 However, preservation of the rostral cervical nerve roots is not necessary, with many surgeons advocating their routine sacrifice in atlantoaxial fusion. Indeed, a recent large case series demonstrates that C2 neurectomy is benign and facilitates exposure as well.…”

Section: Discussionmentioning

confidence: 99%

Axial Spondylectomy and Circumferential Reconstruction via a Posterior Approach

et al. 2013

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Background Spinal metastases of the second cervical vertebra are a subset of tumors that is particularly difficult to address surgically. Previously described techniques require highly morbid circumferential dissection posterior to the pharynx for resection and reconstruction. Objective To perform a biomechanical analysis of instrumented reconstruction configurations used after axial spondylectomy and demonstrate safe use of a novel construct in a patient case report. Methods Several different published and novel reconstruction configurations were inserted into 7 occipitocervical spines that underwent axial spondylectomy. A biomechanical analysis of the constructs’ stiffness in flexion and extension, lateral bending, and rotation was performed. A patient then underwent a posterior-only approach for axial spondylectomy and circumferential reconstruction. Results Biomechanical analysis of different constructs demonstrated that anterior column reconstruction with bilateral cages spanning C1 lateral mass to C3 facet in combination with occipitocervical instrumentation was superior in flexion-extension and equivalent in lateral bending and rotation to currently used constructs. In the patient in which this construct was placed via a posterior-only approach for axial spondylectomy and instrumentation, the patient remained at neurological baseline and demonstrated no recurrence of local disease or failure of instrumentation to date. Conclusion When comparing C1 lateral mass to C3 facet bilateral cage plus occipitocervical instrumentation to existing anterior and posterior constructs, this novel reconstruction is biomechanically equivalent if not superior in performance. In a patient, the posterior-only approach for C2 spondylectomy with the novel reconstruction was safe, durable, and avoided the morbidity of the anterior approach.

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“…Chirurgická léčba je velice obtížná. Naději na vyléčení má jedině kompletní "en bloc" exstirpace se širokými okraji zdravé tkáně (2,16,26,32,34), bez poškození pseudopouzdra, co je těžké dodržet při postižení mobilní páteře, kde nesmíme poškodit míchu a zachovat nervové kořeny. 20) uvádějí lokální recidivu u pacientů s en bloc resekcí ve 28 %, kdežto u pacientů kde bylo porušené pouzdro v 64 %.…”

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Our Experience with Chordoma Treatment

Brindza¹,

Chaloupka²,

Grosman³

2009

Acta Chir. orthop. Traum. Cech.

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Cílem naší studie bylo zhodnotit soubor pacientů operovaných pro chordom na našem pracovišti. Uvádíme možnosti diagnostiky a operačního ošetření podle lokalizace na páteři. Hodnotíme výsledky z hlediska výskytu pooperačních komplikací, recidiv a přežití.Chordom je vzácný nádor se špatnou prognózou, který se vyskytuje na axiálním skeletu, predilekčně v křížové oblasti (50-60 %), intrakraniálně na lebeční bazi a klivu (25-40 %), vzácně se nachází primárně v obratlech mobilní části páteře (9-15 %) (7, 23). Představuje jenom 1 % všech primárních maligních kostních tumorů. Vzniká ze zbytků notochordy, která se tvoří ve 3. týdnu embryonálního vývoje a tvoří základ budoucí páteře. Okolo notochordy se kondenzuje mezenchym -základ obratlů. Jeho malignita byla dlouho podceňována, dnes se zařazuje mezi primární maligní kostní tumory (28, 31), který ale metastázuje vzácně a pozdě v 3-48 % převážně do plic, kůže, jater, kostí, těl jiných obratlů (6,7,9,24,33).Postihuje více muže 2:1, nejčastěji ve věku 40-70 roků, ale může se objevit i u mladších pacientů, dokonce dětí (13,21,27). V našem souboru měl nejmladší pacient 13 roků. Podle Delanka et al. ( 7) se chordom chová jako inkludovaná expanze ohraničená pseudopouzdrem, která roste pomalu, ale agresivně, při velkém objemu i extraoseálně. Tumor expanduje převážně ventrálně, dorzálně a laterálně, protože vertikálnímu šíření brání koncová ploténka obratlového těla a intervertebrální disk.Vzhledem k jeho lokalizaci na páteři a agresivnímu růstu je často nemožné provést jeho radikální resekci 382/PŮVODNÍ PRÁCE ORIGINAL PAPER

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Total Spondylectomy of C2

Cited by 25 publications

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Total spondylectomy of recurrent giant cell tumors in the cervical spine

Total spondylectomy of recurrent giant cell tumors in the cervical spine

Axial Spondylectomy and Circumferential Reconstruction via a Posterior Approach

Our Experience with Chordoma Treatment

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