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Pinter ZW, Moore EJ, Rose PS, Nassr AN, Currier BL. En bloc resection of a high cervical chordoma followed by reconstruction with a free vascularized fibular graft: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22305. [PMID: 36536523 PMCID: PMC9764371 DOI: 10.3171/case22305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Wide excision of chordoma provides better local control than intralesional resection or definitive radiotherapy. The en bloc excision of high cervical chordomas is a challenging endeavor because of the complex anatomy of this region and limited reconstructive options. OBSERVATIONS This is the first case report to describe reconstruction with a free vascularized fibular graft following the en bloc excision of a chordoma involving C1-3. LESSONS This report demonstrates the durability of this construct at 10-year follow-up and is the first case report demonstrating satisfactory long-term oncological outcomes after a true margin-negative resection of a high cervical chordoma.
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Affiliation(s)
| | - Eric J. Moore
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Ahmad N. Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and
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Sadeh M, Farhat H. Severe High Cervical Cord Compression Due to Large Bilateral Neurofibromas in a Patient With Neurofibromatosis Type 1: A Case Report and Review of Literature. Cureus 2022; 14:e27211. [PMID: 36035059 PMCID: PMC9398895 DOI: 10.7759/cureus.27211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/15/2022] Open
Abstract
Spinal neurofibromas are rare benign lesions associated with neurofibromatosis Type 1. They can often cause compression on nerve roots and the spinal cord. In this rare case, there are bilateral large neurofibromas with severe cord compression presenting as progressive myelopathy. We illustrate the surgical management as well as post-operative care along with a detailed literature review of similar cases. To our knowledge, this is the first report, in English literature, of spinal neurofibroma with large size, bilateral high cervical cord compression.
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Bansal K, Singh S, Mallepally AR, Shahi P. Rapid Recurrence of Giant Cell Tumour of C2 Vertebra After Long-Term Denosumab Following Surgical Resection. Cureus 2022; 14:e22000. [PMID: 35282561 PMCID: PMC8906507 DOI: 10.7759/cureus.22000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/20/2022] Open
Abstract
A 25-year-old man presented with symptoms of cervical myelopathy for 10 days. Imaging revealed an expansile, lytic lesion involving the C2 vertebra completely and compressing the spinal cord, suggestive of giant cell tumor (GCT). Tumor resection and posterior stabilization from C1-C4 were done. Histopathology confirmed the diagnosis of GCT. The patient was kept on adjuvant Denosumab (D-ab) for two years with no signs of recurrence. However, discontinuation of D-ab therapy led to recurrence of the tumor within three months, which was managed with repeated surgical resection and anterior instrumentation followed by radiotherapy. To the best of our knowledge, this is the first reported case of GCT involving the upper cervical spine with rapid recurrence following the stoppage of D-ab therapy.
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Yayan J. Denosumab for Effective Tumor Size Reduction in Patients With Giant Cell Tumors of the Bone: A Systematic Review and Meta-Analysis. Cancer Control 2021; 27:1073274820934822. [PMID: 32869648 PMCID: PMC7710399 DOI: 10.1177/1073274820934822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Denosumab is a human monoclonal antibody that has been used successfully in the treatment of giant cell tumors of bone. These tumors are rare and, in principle, benign, but they are highly aggressive, locally advanced, osteolytic bone tumors that can metastasize to the lungs. Denosumab is an effective treatment when these tumors cannot be surgically removed or when surgical resection is likely to lead to severe morbidity (eg, loss of limbs or joints). The aim of this systematic review and meta-analysis was to investigate patients with giant cell tumors of bone who experienced tumor progression during treatment with denosumab and to compare them with patients who experienced reduction of their giant cell tumors of bone during treatment with denosumab. METHODS Embase, Cochrane Library, and MEDLINE/PubMed databases were searched for trials submitted by January 7, 2020, that reported the efficacy and safety of denosumab in patients with giant cell tumors of bone. RESULTS Sixty studies were reviewed, involving a total of 1074 patients who had giant cell tumors of bone and were treated with denosumab. Of the 60 studies, 58% of the patients were from case series studies, 39% from open-label phase II studies, and 3% from case reports. The response rate for denosumab as a treatment for giant cell tumors of bone was 97.5%, with statistical significance (P < .0001). Pain in the limbs was statistically the most common adverse event for denosumab treatment in case series studies (P < .0001). No treatment-related deaths occurred in the reviewed studies. CONCLUSION Cumulative evidence supports the addition of surgery to optimal medical therapy with denosumab to reduce tumor size, clinical symptoms, and mortality among patients with giant cell tumors of bone.
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Affiliation(s)
- Josef Yayan
- Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, HELIOS Clinic Wuppertal, 163483Witten/Herdecke University, Witten, Germany
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Singh PK, Agrawal M, Mishra S, Agrawal D, Sawarkar D, Jagdevan A, Verma S, Doddamani R, Meena R, Garg K, Chandra PS, Kale SS. Management of C2 Body Giant Cell Tumor by Innovatively Fashioned Iliac Crest Graft and Modified Cervical Mesh Cage Used as Plate. World Neurosurg 2020; 140:241-246. [PMID: 32473331 DOI: 10.1016/j.wneu.2020.05.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Locally aggressive vertebral body tumors of the axis must be treated with wide local excision for best outcome. Reconstruction of the load-bearing vertebra needs to be done after tumor resection in such a manner so as to give stable, long-term fusion in this young population. METHODS We describe the management strategy of a 25-year-old acutely quadriplegic patient, with respiratory distress, with a C2 giant cell tumor. The use of a novel iliac crest graft modification used for C2 reconstruction along with a modified mesh cage used as an anterior plate has been reported. RESULTS The patient had a good outcome at 18 months' follow-up, with neurologic improvement and a solid fusion. CONCLUSIONS Iliac crest autograft is inexpensive and easy to harvest and can be considered as a C2 prosthesis, especially in a resource-constrained setting. Modified iliac crest graft can be used for load transmission from C1 lateral mass to C3 body, and the mesh cage can be modified according to need as a plate with good results in an emergency.
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Affiliation(s)
- Pankaj K Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Dattaraja Sawarkar
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Amandeep Jagdevan
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajesh Meena
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Poodipedi S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Sertbaş İ, Karatay M, Hacisalihoğlu UP. Cervical spine giant cell bone tumor: a case report. World J Surg Oncol 2019; 17:82. [PMID: 31078142 PMCID: PMC6511659 DOI: 10.1186/s12957-019-1625-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Giant cell tumors (GCTs) of the bone are locally aggressive primary bone tumors with a benign character. Spinal involvement is rare and they are quite rare in the cervical spine. Case presentation A 31-year-old male patient presented with neck pain. Cervical CT revealed a lytic lesion extending posteriorly and causing the collapse of the C4 vertebra corpus. The patient underwent excision of the tumor extending from the anterior to the posterior with a single-stage anterior intervention followed by the placement of an anterior cage and plate-screw system for fusion. The pathology was reported as GCT. Conclusions The posteriorly located lesion was widely curetted through an anterior approach in a single session.
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Affiliation(s)
- İdris Sertbaş
- Department of Neurosurgery, Yeni Yüzyıl University Medical Faculty, Merkez Mahallesi,Çukurçeşme Caddesi No:51, Gaziosmanpaşa, İstanbul, Turkey.
| | - Mete Karatay
- Department of Neurosurgery, Yeni Yüzyıl University Medical Faculty, Merkez Mahallesi,Çukurçeşme Caddesi No:51, Gaziosmanpaşa, İstanbul, Turkey
| | - Uguray Payam Hacisalihoğlu
- Department of Pathology, Yeni Yüzyıl University Medical Faculty, Merkez Mahallesi, Çukurçeşme Caddesi No:51, Gaziosmanpaşa, İstanbul, Turkey
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Denaro L, Longo UG, Di Martino AC, Maffulli N, Denaro V. Screw migration and oesophageal perforation after surgery for osteosarcoma of the cervical spine. BMC Musculoskelet Disord 2017; 18:552. [PMID: 29284452 PMCID: PMC5747111 DOI: 10.1186/s12891-017-1906-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/11/2017] [Indexed: 11/26/2022] Open
Abstract
Background Even though internal fixation has expanded the indications for cervical spine surgery, it carries the risks of fracture or migration, with associated potential life threatening complications. Removal of metal work from the cervical spine is required in case of failure of internal fixation, but it can become challenging, especially when a great amount of scar tissue is present because of previous surgery and radiotherapy. Case presentation We report a 16 year old competitive basketball athlete who underwent a combined anterior and posterior approach for resection of an osteosarcoma of the sixth cervical vertebra. Fourteen years after the index procedure, the patient eliminated spontaneously one screw through the intestinal tract via an oesophageal perforation and developed a severe dysphagia. Three revision surgeries were performed to remove the anterior plate because of the great amount of post-surgery and post-irradiation fibrosis. Conclusions Screw migration and oesophageal perforation after cervical spine surgery are uncommon potentially life-threatening occurrences. Revision surgery may be challenging and it requires special skills.
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Affiliation(s)
- Luca Denaro
- Neurosurgery, Department of Neurosciences DNS, University Hospital of Padova, Padova, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
| | - Alberto Corrado Di Martino
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy.,Centre for Sport and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Chen G, Li J, Li X, Fan H, Guo Z, Wang Z. Giant cell tumor of axial vertebra: surgical experience of five cases and a review of the literature. World J Surg Oncol 2015; 13:62. [PMID: 25889981 PMCID: PMC4340120 DOI: 10.1186/s12957-015-0438-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Due to the complex anatomy of the upper cervical spinal column region and the variable aggressiveness of giant cell tumors (GCTs), there exists no standard treatment for GCTs of axial vertebra. To the best of our knowledge, there are only a few case reports in the literature and no large sum numbers of clinical trials about the treatment of, or research into, axial vertebra GCTs. Methods Between 2009 and 2013, five patients pathologically diagnosed with axial vertebra GCTs were treated at our hospital. We performed intralesional excision and odontoid process reconstructive surgery to preserve the odontoid process, followed with adjuvant radiation therapy after surgery. Results For those with an intact bone shell, part of the β-TCP (beta tricalcium phosphate) artificial bone could be seen clearly after surgery and became blurred three months after surgery, as seen on a radiograph. One year later, the part of β-TCP artificial bone was fused as a block. Subsequently, autogenous bone regenerated successfully and artificial bone degraded thoroughly. For those with a defective cortical bone, partial fusion of the odontoid process, autograft ilium and third vertebra body could be seen three months after surgery, and complete fusion was seen nine months later. The odontoid process was preserved successfully, and the upper cervical spine was reconstructed effectively, without implant failure or infection. Conclusions In this study, the odontoid process and function of upper cervical vertebra was preserved successfully through lesion curettage, combined with reconstruction with bone grafting, and adjuvant radiation therapy after surgery. During the follow-up periods, no recurrence or complications was observed.
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Affiliation(s)
- Guojing Chen
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Jing Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Xiangdong Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Hongbin Fan
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Zheng Guo
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
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Suchomel P, Barsa P. Single stage total endolesional C2 spondylectomy for chordoma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1453-6. [PMID: 23901402 DOI: 10.1007/s00586-013-2813-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Petr Suchomel
- Neurocenter, Hospital of Liberec, Liberec, Czech Republic.
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Tahasildar N, Sudesh P, Goni V, Tripathy SK. Giant osteochondroma of axis in a child with multiple hereditary exostoses: case report and review of literature. J Pediatr Orthop B 2012; 21:280-5. [PMID: 21956118 DOI: 10.1097/bpb.0b013e32834c3186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Though osteochondromas are the most common benign bone tumour, their spinal involvement is less frequent. We report a case of osteochondroma in a 5-year-old female child with multiple hereditary exostoses that originated from posterior elements of C2 vertebra, not involving spinal canal and caused restriction of neck movement. It was excised from its base without disturbing the continuity of lamina. Two years later she had normal neck movements without any recurrence. The rarity of this tumour at this location, with such a large size at an early age, makes this article unique.
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Affiliation(s)
- Naveen Tahasildar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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11
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Wu JC, Mummaneni PV, El-Sayed IH. Diseases of the odontoid and craniovertebral junction with management by endoscopic approaches. Otolaryngol Clin North Am 2011; 44:1029-42. [PMID: 21978894 DOI: 10.1016/j.otc.2011.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Surgical approaches to the craniovertebral junction (CVJ) can result in dysfunction of the upper aerodigestive tract. However, few data are available regarding the incidence of complications after such surgery. Evaluation of a CVJ lesion for treatment must establish the biology, transverse and longitudinal extent of the lesion, and the preoperative and postoperative stability of the spine. Endoscopic approaches to the CVJ, which should reduce the expected morbidity of an open transoral approach, have been described recently. This article reviews common pathologies of the CVJ and surgical approaches, and provides an evidence-based analysis of whether endoscopic approaches reduce velopharyngeal insufficiency.
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Affiliation(s)
- Jau-Ching Wu
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, San Francisco, CA 94143-0112, USA
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Abstract
To report a rare occurrence of osteoblastoma involving the L4 vertebra in an 8-year-old female child with histological features suggestive of osteoblastoma with secondary aneurysmal changes. The mean age incidence of osteoblastoma is 20.4 years. In our case, a rare presentation of osteoblastoma was seen in the first decade. The child was admitted with a 1-year history of increasing back pain and radiculopathy. The child was evaluated with X-rays, computed tomography scan and magnetic resonance imaging, which indicated involvement of the posterior elements of the 4(th) lumbar vertebrae. Decompression of the L5 nerve and resection of the tumor was performed. Osteoblastoma is a rare tumor with an incidence of 1% of all tumors and 30-40% of cases involving the spine. Osteoblastoma occurs most commonly in males (M:F, 2.5:1). The most common area of involvement is the cervical spine followed by the lumbar spine. Posterior elements of the vertebrae are commonly involved.
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13
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Hans-Joachim Riesner D, Katscher S, Blattert T, Josten C. Posterior Fusion in Patients with Trauma, Instability, and Tumor of the Cervical Spine. Eur J Trauma Emerg Surg 2009; 35:562-79. [PMID: 26815380 DOI: 10.1007/s00068-009-8057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 03/22/2009] [Indexed: 10/20/2022]
Abstract
Trauma, instabilities and tumors of the cervical spine are treated with established methods of surgery. Therefore, anterior fusion is considered to be a standardized procedure for the lower cervical spine, while posterior and anterior instrumentation facilitates stabilization of the upper cervical spine. However, special situations that particularly require posterior instrumentation in traumatic lesions, tumor or other kinds of instabilities arise again and again. Neurological deficit symptoms, bone quality and related diseases fundamentally lead to a decision of posterior access and fusion. Different pathologies and corresponding reasons for posterior surgical interventions on the cervical spine are described in this paper and discussed using the current literature.
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Affiliation(s)
- Dr Hans-Joachim Riesner
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany. .,Department of TraumaPlastic and Reconstructive Surgery, University of Leipzig, Liebigstr 20, 04103, Leipzig, Germany.
| | - Sebastian Katscher
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Thomas Blattert
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe 2 patients of spinal osteoblastoma in upper thoracic lamina, complicated with epidural hematoma and symptoms of cord compression. SUMMARY OF BACKGROUND DATA Review the clinical presentation, radiologic findings, and treatment in these 2 cases, with an emphasis on surgical management and outcomes. METHODS Two patients initially presented with symptoms of incomplete neurological deficit after mild injury. Computer tomography scan indicated osteolytic destruction of thoracic lamina; magnetic resonance imaging illustrated that lesion in the posterior element of thoracic spine with epidural hematoma and sign of spinal cord compression. Marginal surgical resection and hematoma evacuation were performed. RESULTS Histologic diagnosis indicated destructive osteoblastomas with hemorrhage. Complete neurologic recovery was achieved at 1 week and 3 months after surgery. Both patients had no evidence of tumor recurrence at an average follow-up of 37 months. CONCLUSION By using surgical resection and hematoma evacuation, good outcome could be achieved for spinal osteoblastoma complicated with epidural hematoma.
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Three cases of benign giant cell tumor with unusual imaging features. Clin Imaging 2008; 32:407-10. [DOI: 10.1016/j.clinimag.2007.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 01/02/2008] [Indexed: 11/18/2022]
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Suchomel P, Buchvald P, Barsa P, Froehlich R, Choutka O, Krejzar Z, Sourkova P, Endrych L, Dzan L. Single-stage total C-2 intralesional spondylectomy for chordoma with three-column reconstruction. Technical note. J Neurosurg Spine 2007; 6:611-8. [PMID: 17561755 DOI: 10.3171/spi.2007.6.6.17] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chordomas are locally invasive, malignant bone tumors that rarely occur in the cervical spine. En bloc resection or even fully resecting the tumor along its margin offers improved patient survival and a potential disease cure. Complete resection of tumors involving the upper cervical vertebrae requires a combined anterior-posterior approach but is complicated by the presence of vertebral arteries (VAs). In addition, reconstruction of the postresection defect may be prone to failure. The authors present a case of a chordoma involving the axis that was treated using a single-stage total intralesional C-2 spondylectomy with preservation of both VAs because the patient did not tolerate a preoperative occlusion test. A three-column reconstruction technique is also presented.
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Affiliation(s)
- Petr Suchomel
- Department of Neurosurgery, Regional Hospital, Liberec, Czech Republic.
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Hunter CL, Pacione D, Hornyak M, Murali R. GIANT-CELL TUMORS OF THE CERVICAL SPINE. Neurosurgery 2006; 59:E1142-3; discussion E1143. [PMID: 17143206 DOI: 10.1227/01.neu.0000245589.08463.8d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
Giant-cell tumors of bone are rare, benign neoplasms that occur infrequently in the spine above the sacrum, and their presence in the cervical vertebrae is even more exceptional. Although complete en blocsurgical resection is difficult in the cervical spine, treatment with adjuvant radiotherapy has been considered controversial because of a small risk of malignant transformation. The authors report two cases of giant-cell tumors in the cervical vertebrae that were treated successfully with surgical excision and postoperative radiation as well as long-term follow-up.
CLINICAL PRESENTATION
Both patients presented with neck pain radiating into the upper extremities. In both cases, plain radiography, computed tomographic scanning, and magnetic resonance imaging revealed a large destructive process in the vertebral body.
INTERVENTION
In one case, the tumor was treated by anterior resection, then by laminectomy and instrumented fusion, and finally by adjuvant postoperative radiotherapy. In the second case, treatment consisted of radical anterior and posterior resection with instrumented fusion. However, the tumor recurred, and, after several surgical procedures, external beam radiotherapy was administered. The patients have been followed for 17 and 11 years, respectively, with no evidence of tumor recurrence.
CONCLUSION
Radical resection of giant-cell tumors is generally agreed to be the best treatment option. However, complete resection is often not a feasible option for tumors in the cervical spine because of involvement of critical neurovascular structures. In these cases, the benefits of radiotherapy to reduce the risk of local recurrence may well outweigh concerns about the treatment's theoretical risks.
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Affiliation(s)
- Christopher L Hunter
- Department of Neurosurgery, New York Medical College, Munger Pavillion, Valhalla, NY 10595, USA
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18
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George B, Archilli M, Cornelius JF. Bone tumors at the cranio-cervical junction. Surgical management and results from a series of 41 cases. Acta Neurochir (Wien) 2006; 148:741-9; discussion 749. [PMID: 16708168 DOI: 10.1007/s00701-006-0789-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Accepted: 07/26/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bone tumors located at the cranio-cervical junction (CCJ)are rare. Tumoral involvement of the neighbouring structures including bone, nerves and vertebral artery and the dynamic aspects of the bone structures raise technical difficulties in the surgical approach. The surgical management includes tumoral resection and stabilization of the CCJ. METHODS Forty-one patients presenting a bone tumor (26 benign and 15 malignant tumors), excluding chordomas, located at the CCJ (including lower third of the clivus, C1 and C2) were observed over 20 years from 1981 to 2001. Imaging work-up included CT scanner with bone windows sequences and reconstruction in the coronal and sagittal plane; since 1984 most of the patients (N=35) underwent a MRI and angioMR scanning. Vertebral angiography was rarely performed (N=9) and mostly when the diagnosis was doubtful. In some cases the diagnosis was clear but in others, imaging studies showed destructive lesions suggesting a malignancy, which sometimes required a biopsy (N=4). The surgical resection was only performed through a lateral approach. FINDINGS Complete resection was achieved in 38 cases while in 3 cases a small remnant was left behind. A complementary stabilization procedure was necessary in 18 cases using either bone grafting during the same procedure and through the same approach (N=5) or a craniocervical plating and bone grafting (N=13). No recurrence in the group of benign tumors was seen during an average follow-up of 6 years (from 2 to 11 years). The pre-operative symptoms of pain and neck stiffness, improved or disappeared in most patients. Three patients with lower cranial nerves (N=2) or sphincter disturbances (N=1) remained unchanged. One patient with tetraplegia eventually died. CONCLUSIONS Various types of bone tumors may be found at the CCJ. Confusion between benign and malignant tumor or pseudo tumors must be avoided, sometimes requiring a biopsy. Surgery using a lateral approach, usually permits the surgeon to achieve a complete resection either preserving the stability of the CCJ whenever intact or associated with a stabilization procedure.
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Affiliation(s)
- B George
- Department of Neurosurgery, Hopital Lariboisière, Paris, France.
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Bailey CS, Fisher CG, Boyd MC, Dvorak MFS. En bloc marginal excision of a multilevel cervical chordoma. J Neurosurg Spine 2006; 4:409-14. [PMID: 16703909 DOI: 10.3171/spi.2006.4.5.409] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The purpose of this case report is to demonstrate that an en bloc resection with negative surgical margins can be successfully achieved in a case of a seemingly unresectable C-2 chordoma if appropriate preoperative staging and planning are performed. The management of chordomas is controversial and challenging because of their location and often large size at presentation. Because chordomas are malignant and will aggressively recur locally if intralesional resection is conducted, wide or true en bloc resection is generally recommended. The literature indicates, however, that surgeons are reluctant to perform wide or even marginal resections because of the lesion’s complex surrounding anatomy and the risk of significant neurological compromise when a tumor abuts the dura mater or neural tissues. In this report the authors outline the successful en bloc resection of a large C1–3 chordoma and discuss the importance of preoperative staging and planning.
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Affiliation(s)
- Christopher S Bailey
- Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada
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Wu DW, Reginato AJ, Torriani M, Robinson DR, Reginato AM. The crowned dens syndrome as a cause of neck pain: Report of two new cases and review of the literature. ACTA ACUST UNITED AC 2005; 53:133-7. [PMID: 15696551 DOI: 10.1002/art.20915] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- David W Wu
- Massachusetts General Hospital, Boston, USA
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Papagelopoulos PJ, Mavrogenis AF, Currier BL, Katonis P, Galanis EC, Sapkas GS, Korres DS. Primary malignant tumors of the cervical spine. Orthopedics 2004; 27:1066-75; quiz 1076-7. [PMID: 15553947 DOI: 10.3928/0147-7447-20041001-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Schneider M, Sabo D, Gerner HJ, Bernd L. Destructive osteoblastoma of the cervical spine with complete neurologic recovery. Spinal Cord 2002; 40:248-52. [PMID: 11987008 DOI: 10.1038/sj.sc.3101288] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a patient with a large tumor lesion of the 6th vertebrae affecting surrounding soft tissue, and symptoms of cord compression. Histologic diagnosis indicated a destructive osteoblastoma following dorsal and anterior resection and internal fixation. SETTING University Hospital, Germany. METHODS A 23-year old male patient was admitted with a 2-month history of increasing upper extremity weakness and pain. X-ray and MRI indicated massive involvement of the anterior and posterior elements of the 6th vertebrae with a large soft tissue mass. Following emergency decompression and dorsal stabilization, the pathologic investigation revealed a destructive osteoblastoma. Subsequent dorsal and anterior resection with internal fixation were performed. RESULTS The patient initially presented with symptoms of beginning paraplegia of C6/7. According to the neurologic classification of spinal cord injury, motor function score was 56 and sensory function score 83. After emergency dorsal decompression and internal fixation with Luque-Instrumentation he showed increasing neurological recovery. Complete neurological recovery was achieved at 2 and 12-months postoperatively, following secondary dorsal and anterior resection of the tumor and internal fixation with bone cement (PalacosR) and Harms-cage. Radiologic signs of local recurrence were identified 1 year postoperatively. CONCLUSION Osteoblastoma of the cervical spine is rare. Patients often present with severe neurological symptoms due to significant tumor mass. Complete resection is necessary to regain full recovery, to prevent recurrence and, in some cases, malignant transformation.
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Affiliation(s)
- M Schneider
- Department of Orthopaedics, Orthopaedic University Hospital Heidelberg, Germany
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Abstract
Cervical spine tumors, whether primary bone tumors or metastatic tumors, are rare. The possibility of tumors existing must be considered in the differential diagnosis of patients with persistent neck pain, with or without neurologic symptoms, particularly in those with significant pain at night. The clinical presentation is extremely variable, though a history of malignancy should always raise the concern for recurrence. The evaluation and diagnostic assessment includes a thorough physical examination. Radiographic imaging is usually initiated with plain radiographs and additional advanced imaging obtained as indicated. Using appropriate biopsy principles and techniques, tissue is obtained for histologic determination of the suspected lesion before surgical intervention. Treatment options are extremely variable and depend on many factors, including tumor type, location, and patient preference. Treatment warrants a multidisciplinary approach from experienced physicians and is most successfully accomplished in referral centers. Oncologic staging using the Enneking staging system, followed by surgical staging using the Weinstein, Boriani, Biagini system, will aid in the accurate characterization of the tumor load, maximize surgical goals, assure use of appropriate terminology, and provide optimal communication among treatment centers regarding tumor characteristics, treatment efforts, and results.
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Affiliation(s)
- W A Abdu
- Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA.
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Visocchi M, Cioni B, Meglio M, Nizegorodcew T, Moschini M, Ieraci A. Cervical cord compression due to atypical primary neuroectodermal tumor (PNET): one-stage removal and combined cervical spine stabilization. Case report. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1997; 18:177-81. [PMID: 9241567 DOI: 10.1007/bf02048488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The neuroectodermal tumor of bone constitutes a recently isolated neoplasm, which morphologically resembles the peripheral neuroepithelioma of soft tissue. The diagnosis is made by excluding readily classified small round cell neoplasms and then demonstrating the neural origin of the tumor by means of ultrastructural or immunocytochemical studies. CLINICAL CASE We report a case of a primary neuroectodermal tumor (PNET) with atypical findings (primary cervical location, massive vertebral body infiltration and isolated neurological symptomatology). Total tumor removal was achieved by means of a one-stage three-level laminectomy (partial C5, total C6-C7), C6 somatectomy, and combined anterior and posterior cervical spinal instrumentation and fusion. CONCLUSIONS Our case presents three peculiar features: 1) isolated myelopathic symptomatology (first case described); 2) primary isolated massive vertebral cervical involvement with intraspinal epidural extension (first case described); 3) one-stage tumor resection, fusion and instrumentation. Since radiation therapy causes tumor shrinkage but is not curative, radical removal is mandatory even with complex instrumentation procedures.
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Affiliation(s)
- M Visocchi
- Divisione di Neurochirurgia, Università Cattolica, Roma, Italy
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Lindbeck G. Extra-articular calcium pyrophosphate deposition disease presenting as neck pain and fever. Am J Emerg Med 1996; 14:582-5. [PMID: 8857812 DOI: 10.1016/s0735-6757(96)90106-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- G Lindbeck
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, USA
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Abstract
STUDY DESIGN A report of a patient with osteochondroma of the upper cervical spine causing radiculopathy. OBJECTIVES The surgical treatment of this patient involved the complete removal of tumor and compression of neural structures. SUMMARY OF BACKGROUND DATA Osteochondromas affect mostly the long bones. Involvement of spine by solitary osteochondromas is rare condition. The present report represents a case of spinal osteochondroma causing neurologic symptoms. METHODS Cervical osteochondromas, best evaluated with routine magnetic resonance imaging and noncontrast computed tomography scans, rarely contribute to cervical nerve root compression. RESULTS The patient's symptoms gradually resolved after gross total tumor removal. CONCLUSIONS Symptomatic spinal osteochondromas are rare occurrences in an individual surgeon's experience. Computed tomography or magnetic resonance imaging are the imaging procedures of choice. In the majority of patients with myelopathy or radiculopathy, surgery results in complete relief of symptoms as demonstrated in this case.
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Affiliation(s)
- E Arasil
- Department of Neurosurgery, Faculty of Medicine, University of Ankara, Ibn-i Sina (Avicenna) Hospital, Turkey
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Affiliation(s)
- S Menon
- Bloomsbury Rheumatology Unit/Division of Rheumatology, Department of Medicine, University College London, United Kingdom
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Cooke RS, Cumming WJ, Cowie RA. Osteochondroma of the cervical spine: case report and review of the literature. Br J Neurosurg 1994; 8:359-63. [PMID: 7946028 DOI: 10.3109/02688699409029627] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteochondroma of the spine is a rare condition; we report a patient who presented with a spastic tetraparesis due to such a lesion of the second cervical vertebra. Surgical removal resulted in improvement of the original symptoms, but a transient hemiparesis developed postoperatively. Postoperative magnetic resonance imaging was performed and demonstrated a region of myelomalacia at the level of surgery. Survey of the literature confirms the rarity of this lesion and the use of radiology in diagnosis is discussed.
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Affiliation(s)
- R S Cooke
- Department of Neurological Surgery, Hope Hospital, Salford, UK
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