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

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences Vol. 33; no. 1; pp. 126 - 132
• Main Author: 吴巍 李锋 方忠 熊伟 关邯峰 肖骏 郭风劲 陈安民
• Format: Journal Article
• Language: English
• Published: Heidelberg Huazhong University of Science and Technology 01.02.2013; Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
• Subjects: Adult; Axis, Cervical Vertebra - diagnostic imaging; Axis, Cervical Vertebra - surgery; Combined Modality Therapy; Female; Humans; Laminectomy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Radiography; Reconstructive Surgical Procedures - methods; Spinal Neoplasms - diagnostic imaging; Spinal Neoplasms - surgery; Treatment Outcome; Young Adult; 合并; 平均年龄; 手术治疗; 整形外科; 肿瘤患者; 脊椎; 轴; 颈椎; spinal axis tumor resection; spondylectomy; reconstruction; shaped mesh cage; anterior cervical approach
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/s11596-013-1084-0

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.