A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report

Pediatric Neurosurgery ◽

10.1159/000514248 ◽

2021 ◽

pp. 1-7

Author(s):

Marko Jug

Keyword(s):

Cervical Spine ◽

3D Model ◽

Intraoperative Complications ◽

Tumor Resection ◽

Upper Cervical Spine ◽

Spine Instrumentation ◽

Cord Injury ◽

Spinal Navigation ◽

Upper Cervical ◽

3D Printed

Introduction: In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. Case Presentation: We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. Discussion/Conclusion: Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.

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Nonoperative Management of Vertical C2 Body Fractures

Neurosurgery ◽

10.1227/01.neu.0000153908.53579.e4 ◽

2005 ◽

Vol 56 (3) ◽

pp. 516-521 ◽

Cited By ~ 31

Author(s):

John W. German ◽

Blaine L. Hart ◽

Edward C. Benzel

Keyword(s):

Cervical Spine ◽

Nonoperative Management ◽

Upper Cervical Spine ◽

Cervical Spine Injuries ◽

Body Fracture ◽

Cord Injury ◽

Spine Injuries ◽

Upper Cervical

Abstract OBJECTIVE: To estimate the incidence and to describe the clinical results of the nonoperative management of vertical C2 body fractures. METHODS: An 8-year retrospective review of upper cervical spine injuries from the registry of a level I trauma center identified 21 patients with a vertical C2 body fracture. RESULTS: Sixteen coronally oriented Type 1 vertical C2 body fractures and 5 sagittally oriented Type 2 vertical C2 body fractures were identified. These fractures account for approximately 10% of the upper cervical spine fractures identified over this period of time. One elderly patient with a Type 1 fracture died as a result of pneumonia, and two patients with Type 2 fractures died from severe closed-head injuries. One patient had evidence of spinal cord injury. This was not related to the C2 body fracture but rather to a subaxial cervical spine injury. Of the surviving 18 patients, all were managed nonoperatively (with external orthoses) and showed evidence of fusion (union of fracture fragments) at the time of the last follow-up. CONCLUSION: Vertical C2 body fractures are not rare injuries and can account for up to 10% of upper cervical spine injuries. In general, vertical C2 body fractures are amenable to nonoperative treatment with external orthoses.

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Posterior Resection via Atlantoaxial Lamina Space Without Internal Fixation for C1-C2 Intraspinal Tumors: A Novel Approach

10.21203/rs.3.rs-64404/v1 ◽

2020 ◽

Author(s):

Beiping Ouyang ◽

Xiaobao Zou ◽

Ling Ni ◽

Su Ge ◽

Yuyue Chen ◽

...

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Statistical Significance ◽

Tumor Resection ◽

Neck Disability Index ◽

Upper Cervical Spine ◽

One Stage ◽

Flexion Extension ◽

Upper Cervical

Abstract Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation.Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up.Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.

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Complications of Posttraumatic Dorsal Cervical Spine Fusion

10.21203/rs.3.rs-97250/v1 ◽

2020 ◽

Author(s):

Adnan Kasapovic ◽

Kristian Welle ◽

Roslind Hackenberg ◽

Desirée Schwetje ◽

Charlotte Rommelspacher ◽

...

Keyword(s):

Cervical Spine ◽

Intraoperative Complications ◽

Spine Fusion ◽

University Hospital ◽

Upper Cervical Spine ◽

Revision Operation ◽

Cervical Spine Injuries ◽

Upper Cervical ◽

Cervical Spine Fusion ◽

Cervical Spine Fractures

Abstract Background: This study evaluates the occurence of complications of dorsal cervical spine fusion after cervical spine injuries. Methods:Dorsal cervical spine fusion due to fractures of the cervical spine was performed in 40 patients. During the first 6 postoperative weeks the occurrence of complications was observed.Results:In most cases the dorsal fusion was performed in the upper cervical spine. Severe systemic diseases were common in the cohort. No intraoperative complications, implant malpositioning or postoperative neurologic deficits were observed. In 3 cases a revision operation was performed due to surgical site infection. General complications were common (19 cases = 47.5 %) with pneumonia (20%) and cardial complications (12.5%) as the most frequent complications. In 2 cases (5%) the complications led to death due to sepsis and cardiogenic shock. Conclusions: Following the findings of our study there is a low surgical revision and complication rate after dorsal cervical spine fusion, while the rate of general complications appears to be much higher. Taking these complications into account cervical fusion operations should carefully be taken into consideration as a therapy option in cervical spine fractures. Trial registration: All procedures performed in the present study were in accordance with the ethical standards approved by the Ethical Committee of University Hospital Bonn, Bonn, Germany (reference number: 406/17)

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Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent With Ewing Sarcoma

Spine ◽

10.1097/brs.0000000000001179 ◽

2016 ◽

Vol 41 (1) ◽

pp. E50-E54 ◽

Cited By ~ 131

Author(s):

Nanfang Xu ◽

Feng Wei ◽

Xiaoguang Liu ◽

Liang Jiang ◽

Hong Cai ◽

...

Keyword(s):

Cervical Spine ◽

Vertebral Body ◽

Ewing Sarcoma ◽

Upper Cervical Spine ◽

Upper Cervical ◽

3D Printed

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Upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2

Annals of Translational Medicine ◽

10.21037/atm.2020.03.32 ◽

2020 ◽

Vol 8 (6) ◽

pp. 332-332

Author(s):

Feng Wei ◽

Zhehuang Li ◽

Zhongjun Liu ◽

Xiaoguang Liu ◽

Liang Jiang ◽

...

Keyword(s):

Cervical Spine ◽

Vertebral Body ◽

Upper Cervical Spine ◽

Primary Tumors ◽

Upper Cervical ◽

3D Printed

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Surgical management of coincidental metastases to upper cervical spine and skull from hepatocellular carcinoma: a case report

Journal of International Medical Research ◽

10.1177/0300060518800875 ◽

2018 ◽

Vol 46 (11) ◽

pp. 4852-4859 ◽

Cited By ~ 1

Author(s):

Hiroshi Uei ◽

Yasuaki Tokuhashi ◽

Masafumi Maseda ◽

Masahiro Nakahashi ◽

Hirokatsu Sawada ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Cervical Spine ◽

Postoperative Radiotherapy ◽

Tumor Resection ◽

Occipital Bone ◽

Upper Cervical Spine ◽

Spine Metastases ◽

Upper Cervical ◽

Bone Tumor Resection ◽

Instrumentation Failure

Metastases to the skull or upper cervical spine from hepatocellular carcinoma (HCC) are very rare. We herein report a unique case of two-site surgery for both skull and upper cervical spine metastases from HCC. The patient was a 64-year-old man with cervical pain. Computed tomography (CT) revealed osteolytic change related to metastatic cervical spine and occipital bone tumors. Two-stage surgery involving posterior occipitocervical fusion and occipital bone tumor resection was performed. The patient’s pain decreased in severity, and postoperative radiotherapy and chemotherapy could be conducted. The postoperative course was favorable, and the patient exhibited improvement in his activities of daily living. Neither cervical spine X-ray examination nor CT showed any instrumentation failure, such as screw loosening, before the patient died of liver failure 13 months after surgery. Patients with both skull and upper cervical spine metastases from liver cancer may have a markedly unfavorable prognosis. Even in these patients, however, surgery as an aggressive palliative treatment may prolong the survival period or maintain the quality of life as long as the patient’s general condition permits.

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Posterior resection via atlantoaxial lamina space without internal fixation for C1-C2 intraspinal tumors: A novel approach

10.21203/rs.3.rs-64404/v2 ◽

2020 ◽

Author(s):

Beiping Ouyang ◽

Xiaobao Zou ◽

Ling Ni ◽

Su Ge ◽

Yuyue Chen ◽

...

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Statistical Significance ◽

Tumor Resection ◽

Neck Disability Index ◽

Upper Cervical Spine ◽

One Stage ◽

Flexion Extension ◽

Upper Cervical

Abstract Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation. Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up. Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.

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