Use of Intraoperative Navigation for Reconstruction of the C1 Lateral Mass After Resection of Aneurysmal Bone Cyst

Reconstruction of C1 lateral mass with an expandable cage in addition to vertebral artery preservation: presenting two cases

PURPOSE

C1 lateral mass reconstruction is recommended, in cases of instability caused by tumor involvement or extensive C1 lateral mass resection. However, because of the anatomical complexity of the area and, most importantly, the proximity to vertebral arteries, few cases of reconstruction have been reported to date. The purpose of this report is to present technical details of C1 lateral mass reconstruction in conjunction with vertebral artery preservation from a posterior approach.

METHODS

Two cases of one stage craniovertebral junction instrumentation and C1 lateral mass reconstruction in conjunction with vertebral artery preservation from a posterior approach are presented.

RESULTS

In both cases of extensive resection of lateral mass due to tumor involvement, an expandable cage was used for C1 lateral mass reconstruction, which has been used only in one patient in literature. Complementary pathological examinations of the two cases indicated two rare tumors that had been reported in the upper cervical region so far. The first case became an unknown origin metastatic cancer and the second was reported to be a primary non- Hodgkin lymphoma.

CONCLUSIONS

C1 lateral mass reconstruction with an expandable cage together with VA preservation is recommended in cases of extensive C1 lateral mass resection to increase the total strength and to shorten the length of the posterior device and probably better fusion. The expandable cage is preferred because of safer placement under compression instead of the lateral mass.

Reconstruction of the cervical lateral mass using 3D-printed prostheses

Objective

This study aimed to investigate the outcome of using 3-dimensional (3D)-printed prostheses to reconstruct a cervical lateral mass to maintain cervical stability.

Methods

We retrospectively analyzed data of 7 patients who underwent cervical lateral mass reconstruction using a 3D-printed prosthesis, comprising axial and subaxial lateral mass reconstruction in 2 and 5 patients, respectively. Bilateral mass was reconstructed in 1 patient and unilateral mass in the remaining 6 patients.

Results

Using a 3D-printed lateral mass prosthesis, internal fixation was stable for all 7 patients postoperatively. No implant-related complications such as prosthesis loosening, displacement, and compression were observed at the last follow-up.

Conclusion

Reconstruction of the lateral mass structure is beneficial in restoring load transfer in the cervical spine under physiological conditions. A 3D-printed prosthesis can be considered a good option for reconstruction of the lateral mass as fusion was achieved, with no subsequent complications observed.

Use of image-guided bone scalpel for resection of spine tumors: technical note

In the literature, the use of navigation for spine tumor surgery has largely centered on implant placement. We describe the cases of two patients with spinal tumors on whom we utilized our resection technique of registering an ultrasonic bone scalpel (UBS) to a navigation system. In both cases, we achieved a satisfactory tumor resection with negative margins and excellent neurologic outcomes. We feel that using the navigation-registered UBS is a valuable tool to increase the operator's ability to achieve desired resections while minimizing the neurologic deficits and operative morbidity associated with these challenging surgical cases.