Abstract
Management of metastatic spinal disease in the upper cervical spine can be particularly challenging. Depending on the level of the lesion and the patient’s anatomy, multiple anterior approaches have been described for resection of the cancer, followed by posterior fixation and instrumentation. Although a single-stage posterolateral approach is now well established for thoracic pathology, less is known about the applicability of these principles when applied as an approach to the cervical spine. The authors present here a case using a posterolateral transpedicular approach for corpectomy and graft placement for circumferential reconstruction as a treatment of metastatic disease in the cervical spine to illustrate the feasibility of this technique, especially in the setting where the patient’s anatomy or pathology may impede an anterior or combined circumferential approach.
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References
Jacobs WB, Perrin RG (2001) Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 11:e10
Altaf F, Weber M, Dea N, Boriani S, Ames C, Williams R et al (2016) An evidence-based review and survey of expert opinion of reconstruction of metastatic spine tumors. Spine (Phila Pa 1976) 41:254–261. https://doi.org/10.1097/brs.0000000000001819
Eleraky M, Setzer M, Vrionis FD (2010) Posterior transpedicular corpectomy for malignant cervical spine tumors. Eur Spine J 19:257–262. https://doi.org/10.1007/s00586-009-1185-4
Cusick JF, Yoganandan N, Pintar F, Myklebust J, Hussain H (1988) Biomechanics of cervical spine facetectomy and fixation techniques. Spine (Phila Pa 1976) 13:808–812. https://doi.org/10.1097/00007632-198807000-00017
Cahill DW, Kumar R (1999) Palliative subtotal vertebrectomy with anterior and posterior reconstruction via a single posterior approach. J Neurosurg 90:42–47
Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH (2000) Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine (Phila Pa 1976) 25:2240–2249. https://doi.org/10.1097/00007632-200009010-00016 (discussion 250)
Vrionis FD, Small J (2003) Surgical management of metastatic spinal neoplasms. Neurosurg Focus 15:E12. https://doi.org/10.3171/foc.2003.15.5.12
Loblaw DA, Perry J, Chambers A, Laperriere NJ (2005) Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the cancer care Ontario practice guidelines initiative’s neuro-oncology disease site group. J Clin Oncol 23:2028–2037. https://doi.org/10.1200/JCO.2005.00.067
Shen FH, Marks I, Shaffrey C, Ouellet J, Arlet V (2008) The use of an expandable cage for corpectomy reconstruction of vertebral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients. Spine J 8:329–339. https://doi.org/10.1016/j.spinee.2007.05.002
Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam JB et al (1998) Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg 89:599–609. https://doi.org/10.3171/jns.1998.89.4.0599
Ames CP, Wang VY, Deviren V, Vrionis FD (2009) Posterior transpedicular corpectomy and reconstruction of the axial vertebra for metastatic tumor. J Neurosurg Spine 10:111–116. https://doi.org/10.3171/2008.11.SPI08445
Tuzun Y, Izci Y, Sengul G, Erdogan F, Suma S (2005) Neurenteric cyst of the upper cervical spine: excision via posterior approach. Pediatr Neurosurg 42:54–56. https://doi.org/10.1159/000089511
Acosta FL, Aryan HE, Chi J, Parsa AT, Ames CP (2007) Modified paramedian transpedicular approach and spinal reconstruction for intradural tumors of the cervical and cervicothoracic spine: clinical experience. Spine (Phila Pa 1976) 32:E203–E210. https://doi.org/10.1097/01.brs.0000257567.91176.76
Ying Z, Wen Y, Xinwei W, Yong T, Hongyu L, Zhu H et al (2008) Anterior cervical discectomy and fusion for unstable traumatic spondylolisthesis of the axis. Spine (Phila Pa 1976) 33:255–258. https://doi.org/10.1097/brs.0b013e31816233d0
Wilson AJ, Marshall RW, Ewart M (1999) Transoral fusion with internal fixation in a displaced hangman’s fracture. Spine (Phila Pa 1976) 24:295–298. https://doi.org/10.1097/00007632-199902010-00022
Smith G, Robinson R (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Jt Surg Am 40:607–624
Robinson R, Smith G (1955) Anterolateral cervical disk removal and interbody fusion for cervical disk syndrome. Bull Johns Hopkins Hosp 96:223–224
Zhang Y, Zhang J, Wang X, Chen D, Yuan W (2013) Application of the cervical subaxial anterior approach at C2 in select patients. Orthopedics 36:e554–e560. https://doi.org/10.3928/01477447-20130426-15
Russo A, Albanese E, Quiroga M, Ulm AJ (2009) Submandibular approach to the C2–3 disc level: microsurgical anatomy with clinical application. J Neurosurg Spine 10:380–389. https://doi.org/10.3171/2008.12.SPINE08281
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Pham, M.H., Bakhsheshian, J. Posterolateral cervical transpedicular corpectomy for the surgical management of metastatic tumor. Eur Spine J 27, 827–832 (2018). https://doi.org/10.1007/s00586-018-5466-7
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DOI: https://doi.org/10.1007/s00586-018-5466-7