Sequentially Staged Resection and 2-Column Reconstruction for C2 Tumors Through a Combined Anterior Retropharyngeal–Posterior: Approach Surgical Technique and Results in 11 Patients

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons184-ons194 ◽  
Author(s):  
Xinghai Yang ◽  
Zhipeng Wu ◽  
Jianru Xiao ◽  
Honglin Teng ◽  
Dapeng Feng ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Posterior Approach ◽  
Tumor Resection ◽  
The Other ◽  
Neurological Improvement ◽  
Experienced Pain ◽  
Alive With Disease ◽  
Solid Fusion ◽  
Deep Location

Abstract BACKGROUND Surgical treatment of C2 tumors remains challenging. Because of the deep location and unique anatomical complexity, anterior exposure in this region is considered difficult and dangerous, and few reports concerning anterior tumor resection and reconstruction exist. OBJECTIVE To describe a technique of sequentially staged resection and 2-column reconstruction for C2 tumors through a combined anterior retropharyngeal–posterior approach. METHODS Eleven patients with C2 tumors underwent sequentially staged tumor resection and 2-column reconstruction in our institute. Eight primary lesions and 3 metastases were involved. Tumor resections and anterior reconstructions with conventional constructs were accomplished by an anterior retropharyngeal approach, and occipitocervical fusions through posterior access were performed in the same anesthesia. RESULTS No operative mortality occurred in this series. All patients experienced pain relief and neurological improvement after surgery. Except for 1 incidence of screw pullout, which was corrected by revision surgery, solid fusion was achieved in all patients. A follow-up period of 12 to 37 months was available for this study. Two patients with chordoma relapsed; 1 died of disease, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases. No evidence of local recurrence was found in the other patients. CONCLUSION The anterior retropharyngeal approach is a favorable route to treat tumor lesions of the C2 vertebral body that allows tumor resection and placement of anterior constructs between C1 and the subaxial vertebral body. Tumor resection and 2-column reconstruction could safely be accomplished simultaneously through the combined anterior retropharyngeal–posterior approach.

Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization

1985 ◽  
Vol 63 (5) ◽  
pp. 676-684 ◽  
Author(s):  
Narayan Sundaresan ◽  
Joseph H. Galicich ◽  
Joseph M. Lane ◽  
Manjit S. Bains ◽  
Patricia McCormack
Keyword(s):  
Vertebral Body ◽  
De Novo ◽  
Cord Compression ◽  
Cervical Region ◽  
Lumbar Region ◽  
Content Type ◽  
Prior Therapy ◽  
Results Of Treatment ◽  
Experienced Pain

✓ The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients), and a variety of others (35 patients). Of the 101 patients, 23 received surgery de novo; the remaining 78 patients had undergone previous therapy. Sites of involvement included the cervical region in 13 patients, the thoracic region in 68 patients, and the lumbar region in 20 patients. Prior to surgery, severe pain was noted in 90% of the patients, and 45% were non-ambulatory. Using an anterolateral surgical exposure, the vertebral body was resected along with all epidural tumor. Immediate stabilization was achieved with methyl methacrylate and Steinmann pins. Following surgery, the overall ambulation rate was 78%, and 85% of patients experienced pain relief. Of the 23 patients who had received no prior therapy, 90% continued to be ambulatory at their last follow-up examination or until death. The authors believe that surgery prior to irradiation is indicated in selected patients with neoplastic cord compression. In patients with solitary osseous metastasis to the spine, potentially curative resection can be undertaken if surgery is performed when the tumor is still confined to the vertebral body.

scholarly journals Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection

2003 ◽  
Vol 15 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Issada Thongtrangan ◽  
Raju S. V. Balabhadra ◽  
Hoang Le ◽  
Jon Park ◽  
Daniel H. Kim
Keyword(s):  
Vertebral Body ◽  
Tumor Resection ◽  
Anterior Column ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Wide Resection ◽  
Primary Tumors ◽  
Expandable Cage ◽  
Expandable Cages

Object The authors report their clinical experience with expandable cages used to stabilize the spine after verte-brectomy. The objectives of surgical treatment for spine tumors include a decrease in pain, decompression of the neural elements, mechanical stabilization of the spine, and wide resection to gain local control of certain primary tumors. Most of the lesions occur in the anterior column or vertebral body (VB). Anterior column defects following resection of VBs require surgical restoration of anterior column support. Recently, various expandable cages have been developed and used clinically for VB replacement (VBR). Methods Between January 2001 and June 2003, the authors treated 15 patients who presented with primary spinal tumors and metastatic lesions from remote sites. All patients underwent vertebrectomy, VBR with an expandable cage, and anterior instrumentation with or without posterior instrumentation, depending on the stability of the involved segment. The correction of kyphotic angle was achieved at an average of 20°. Pain scores according to the visual analog scale decreased from 8.4 to 5.2 at the last follow-up review. Patients whose Frankel neurological grade was below D attained at least a one-grade improvement after surgery. All patients achieved immediate stability postsurgery and there were no significant complications related to the expandable cage. Conclusions The advantage of the expandable cage is that it is easy to use because it permits optimal fit and correction of the deformity by in vivo expansion of the device. These results are promising, but long-term follow up is required.

scholarly journals Osteoid Osteoma and Osteoblastoma of the Cervical Spine: The Cause of Unusual Persistent Neck Pain

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 549-554
Author(s):  
Tuncay Kaner
Keyword(s):  
Cervical Spine ◽  
Retrospective Study ◽  
Neck Pain ◽  
Osteoid Osteoma ◽  
Tumor Resection ◽  
Spinal Instrumentation ◽  
The Other ◽  
Neurological Deficits ◽  
Common Symptom

Background: The most important symptom in patients with osteoid osteoma and osteoblastoma is a resistant localized neck pain and stiffness in the spine. Objective: To evaluate and analyze 6 cases of osteoid osteoma and osteoblastoma of the cervical spine that were surgically treated over a 7-year period and to emphasize the unusual persistent neck pain associated with osteoid osteoma and osteoblastoma of the cervical spine. Study Design: Retrospective study. Methods: Six patients, 3 male and 3 female, with a mean age of 21 years (range 16-31) diagnosed with osteoid osteoma or osteoblastoma during 2003 to 2009 were analyzed retrospectively. The preoperative neurological and clinical symptoms, neck pain duration, preoperative deformity, location of lesion, radiological findings, surgical technique and clinical follow-up outcomes of each patient were evaluated. Results: The average follow-up duration was 40.5 months (range, 19 to 83 months). Three patients had osteoid osteoma (2 female and one male), and 3 patients had osteoblastoma (one female and 2 male). Two male patients had recurrent osteoblastoma. The locations of the lesions were as follows: C7 (2 patients), C3 (one patient), C2 (one patient), C3-C4 (one patient) and C5-C6 (one patient). The most common symptom was local neck pain in the region of the tumor. Among all patients, only one patient, who had osteoblastoma, had neurological deficits (right C5-C6 root symptoms). The other patients had no neurological deficits. All patients were treated with surgical resection using microsurgery. Two patients underwent only tumor resection, one patient underwent tumor resection and fusion, and the other 3 patients underwent tumor resection, fusion and spinal instrumentation. No perioperative complications developed in any of our patients. There was no tumor recurrence during the follow-up period. Limitations: A retrospective study with 6 analyses of cases. Conclusion: Surgical treatment of osteoid osteoma and osteoblastoma of the spine has been standardized. The most common symptom of osteoid osteoma and osteoblastoma of the cervical spine is local persistent neck pain in the region of the tumor. This symptom can be significant in the diagnosis of these tumors. Key words: neck pain, osteoid osteoma, osteoblastoma, bone tumors, cervical spine

scholarly journals Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

2019 ◽  
Vol 10 (02) ◽  
pp. 225-233
Author(s):  
Mantu Jain ◽  
Rabi Narayan Sahu ◽  
Sudarsan Behera ◽  
Rajesh Rana ◽  
Sujit Kumar Tripathy ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Vertebral Body ◽  
Posterior Approach ◽  
Spinal Tuberculosis ◽  
X Rays ◽  
Analog Scale ◽  
Bony Fusion ◽  
Universal Approach ◽  
The Mean

ABSTRACT Background: Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach. Settings and Design: A retrospective case study series in a tertiary level hospital. Aims: The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a “universal approach” in tubercular spondylodiscitis of variable presentation. Materials and Methods: The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period. Statistical Analysis Used: The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired t-test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis. Results: The mean number of vertebrae involved was 3.29 ± 0.86 (2–6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause. Conclusions: The procedure in safe and has satisfactory results in variable group affection of Pott’s spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.

Limited Wrist Arthrodesis for the Salvage of SLAC Wrist

1997 ◽  
Vol 22 (4) ◽  
pp. 461-465 ◽  
Author(s):  
D. R. J. GILL ◽  
D. C. R. IRELAND
Keyword(s):  
Grip Strength ◽  
The Other ◽  
Salvage Procedure ◽  
Early Failure ◽  
Wrist Arthrodesis ◽  
Mild Pain ◽  
Solid Fusion ◽  
Slac Wrist

We report the results of limited wrist arthrodesis, a salvage procedure for SLAC wrist. It involves excision of the scaphoid, radial styloidectomy and fusion of the lunate to the capitate and the triquetrum to the hamate, using cancellous lag screws. Twenty-four wrists in 22 patients were reviewed retrospectively at an average follow-up of 23 months. Seventeen of the 22 patients had no pain or mild pain and had retained a mean arc of motion of 48°. Grip strength was 70% of the other side. Four of the 24 patients developed non-unions, two of which had successful revision to limited wrist arthrodesis. The other two required pan arthrodesis of the wrist. Two other patients with persisting pain in spite of solid fusion were also treated by pan arthrodesis of the wrist. Radial styloidectomy did not result in early failure of this procedure and secondary ulnar translocation of the carpus was not seen.

Total L-5 spondylectomy and reconstruction of the lumbosacral junction

2007 ◽  
Vol 7 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Gary L. Gallia ◽  
Daniel M. Sciubba ◽  
Ali Bydon ◽  
Ian Suk ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Pedicle Screws ◽  
Allograft Bone ◽  
Lumbosacral Junction ◽  
Second Stage ◽  
Iliac Screws ◽  
Vascular Structures

✓The authors describe a technique for total L-5 spondylectomy and reconstruction of the lumbosacral junction. The technique, which involves separately staged posterior and anterior procedures, is reported in two patients harboring neoplasms that involved the L-5 level. The first stage consisted of a posterior approach with removal of all posterior bone elements of L-5 and radical L4–5 and L5–S1 discectomies. Lumbosacral and lumbopelvic instrumentation included pedicle screws as well as iliac screws or a transiliac rod. The second stage consisted of an anterior approach with mobilization of vascular structures, completion of L4–5 and L5–S1 discectomies, and removal of the L-5 vertebral body. Anterior lumbosacral reconstruction included placement of a distractable cage and tension band between L-4 and S-1. Allograft bone was used for fusion in both stages. No significant complications were encountered. At more than 1 year of follow-up, both patients were independently ambulatory, without evidence of recurrent or metastatic disease, and adequate lumbosacral alignment was maintained. The authors conclude that this technique can be safely performed in appropriately selected patients with neoplasms involving L-5.

scholarly journals A 540° posterior-anterior-posterior approach for 360° fused rigid severe cervical kyphosis: patient series

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Posterior Approach ◽  
Tumor Resection ◽  
Case Series ◽  
Combined Approach ◽  
Cervical Kyphosis ◽  
Anterior Plate ◽  
Bone Fusion ◽  
Posterior Anterior ◽  
Anterior Posterior

BACKGROUND Treatment of severe rigid 360° fused cervical kyphosis (CK) is challenging and often requires a combined approach for ankylosis release, establishment of sagittal balance, and fixation with fusion. OBSERVATIONS Four patients with iatrogenic 360° fused severe rigid CK (Cobb angle ≥40°) were enrolled for this retrospective analysis. All patients in the case series were female, with an average age of 27 years. All patients previously underwent posterior laminectomy/laminoplasty and cervical tumor resection when they were children (13–17 years). They underwent correction surgery with a 540° posterior-anterior-posterior approach. Preoperative and final follow-up radiography and computed tomography (CT) were used to evaluate kyphosis correction, internal fixation implants, and bone fusion. The preoperative and final follow-up average C2–7 Cobb angles were −32.4° ± 12.0° and 5.3° ± 7.1°, respectively. Preoperative and final follow-up CK angles averaged −47.2° ± 7.4° and −0.9° ± 16.1°, respectively. The mean correction angle was 46.3° ± 9.6°. At final follow-up, CT showed stable fixation and solid bone fusion. LESSONS The rare iatrogenic severe kyphosis with 360° ankylosis requires a combined approach. The 540° posterior-anterior-posterior approach can completely release the bony fusion, and the CK can be corrected using an anterior plate. This technique can achieve good results and is an effective strategy.

scholarly journals The dynamic natural history of cerebral aneurysms from cardiac myxomas: A review of the natural history of myxomatous aneurysms

2018 ◽  
Vol 24 (3) ◽  
pp. 277-283 ◽  
Author(s):  
Paloma Largo Flores ◽  
Felix Haglund ◽  
Pervinder Bhogal ◽  
Leonard Yeo Leong Litt ◽  
Michael Södermann
Keyword(s):  
Natural History ◽  
Tumor Resection ◽  
Cardiac Myxoma ◽  
Previous History ◽  
Cerebral Aneurysms ◽  
The Other ◽  
Conventional Angiography ◽  
History Of ◽  
Cardiac Myxomas

We describe two contrasting patients with multiple cerebral aneurysms and a previous history of resected cardiac myxomas with no cardiac recurrence on follow-up echocardiography. Both patients presented with stroke- like symptoms; one with a left visual defect and the other with right hemiplegia. Magnetic resonance imaging of the brain of both patients showed the presence of multiple cerebral aneurysms that was later confirmed on conventional angiography. Both patients’ aneurysms were managed conservatively. Serial angiograms were performed during their follow-up, which spanned several years. One patient’s aneurysms remained static while the evolution of the other patient’s aneurysms displayed a dynamic quality with some increasing in size while others diminished. This is the first description in which some aneurysms progressed while others regressed simultaneously in the same patient. Aneurysms in patients with a history of cardiac myxoma can be active years after primary tumor resection and it is difficult to predict how they will develop. We reviewed the literature of all patients with multiple myxomatous aneurysms who were treated conservatively to better understand the natural history of this rare disease. Long-term follow-up of these patients may be necessary.

The Use of a 95° Blade Plate and a Posterior Approach to Achieve Tibiotalocalcaneal Arthrodesis

2002 ◽  
Vol 23 (8) ◽  
pp. 704-710 ◽  
Author(s):  
Travis W. Hanson ◽  
Andrea Cracchiolo
Keyword(s):  
Pain Relief ◽  
Internal Fixation ◽  
Posterior Approach ◽  
Split Thickness Skin Graft ◽  
Blade Plate ◽  
Thickness Skin ◽  
Solid Fusion ◽  
Post Traumatic ◽  
Hindfoot Deformity

Various types of internal fixation have been used to achieve arthrodesis of both the ankle and subtalar joints. We have investigated the use of a standard 95° angled blade plate as a method of more rigid internal fixation to achieve arthrodesis of these joints. The purpose of this retrospective study was to review our clinical and radiographic results in adults using a blade plate applied through a posterior approach to fuse the ankle and subtalar joints. Methods: Between April 1995 and June 2000, 10 tibiotalocalcaneal arthrodeses were performed using a posterior approach and a blade plate for internal fixation. There were 10 adults (five men and five women) whose average age was 64 years (range, 42 to 80 years). The indication for the procedure was severe pain which was unresponsive to nonoperative management in patients with arthritic joints. Preoperative diagnoses included six patients with post-traumatic arthritis, two with primary degenerative arthritis, one with rheumatoid arthritis, and one with post-polio deformity. An average of 1.7 previous operations had been performed on the affected ankle. Results: Clinical and radiographic follow-up was performed for all patients at an average of 37 months (range, 12 to 71 months) postoperatively. All 10 patients achieved a solid fusion. The mean time to radiographic fusion was 14.5 weeks (range, 9 to 26 weeks). The operation resulted in plantigrade feet in all patients with an average tibia-floor angle of 2.3° of dorsiflexion and an average of 5° of hindfoot valgus. Patients had excellent pain relief, however function did not improve as much. Complications occurred in three patients. One patient required a small split-thickness skin graft for wound healing, one experienced a transient posterior tibial nerve neuropraxia, and one developed a deep venous thrombosis in the nonoperative leg at six weeks postoperatively. Three patients required removal of the blade plate because of discomfort, which promptly cleared. Conclusions: Arthrodesis provides excellent pain relief for patients with painful arthritic deformities of the ankle and subtalar joints. Using a posterior approach, a blade plate for internal fixation and bone grafts resulted in a solid fusion for all our patients. This method is particularly effective in large patients with a mild-moderate hindfoot deformity.

scholarly journals Is correction of kyphosis necessary by posterior approach for the treatment of multilevel cervical degenerative myelopathy? An observational study

2020 ◽  
Author(s):  
Wei Du ◽  
Shuai Wang ◽  
Haixu Wang ◽  
Jingtao Zhang ◽  
Feng Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Recovery Rate ◽  
Posterior Approach ◽  
Neck Disability Index ◽  
Japanese Orthopedic Association ◽  
Neurological Improvement ◽  
Curvature Index ◽  
Degenerative Myelopathy ◽  
Neck Disability

Abstract Background: The purpose of this study was to determine whether sagittal lordotic alignment, clinical outcomes and axial symptoms (AS) could be improved by kyphotic correction after posterior approach for multilevel cervical degenerative myelopathy (CDM).Methods: We retrospectively reviewed 109 patients with multilevel CDM with kyphosis who had undergone laminoplasty (Group LP, 53 patients) and laminectomy with lateral mass screw fixation (Group LCS, 56 patients) between January 2014 and December 2018. Curvature index (CI) was measured according to the pre- and postoperative radiographic parameters. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified by Neck Disability Index (NDI).Results: Analysis of postoperative follow-up data showed significant differences in CI (t = 8.64, P < 0.001), correction of CI (t = 8.97, P < 0.001) and NDI (t = 3.37, P < 0.001) between Group LP and LCS, whereas no significant differences in JOA score (t = 1.21, P = 0.23) and recovery rate (t = 1.52, P = 0.13). There were significant differences in JOA score (t = 98.29, 96.41, P < 0.001), CI (t = 17.07, 16.17, P < 0.001) and NDI (t = 37.46, 52.15, P < 0.001) between pre- and postoperative follow-up in Group LP and LCS. Correction of CI showed negative correlation with axial symptom severity (r = -0.51, P < 0.001), and no association with recovery rate (r = 0.14, P = 0.15).Conclusions: Satisfied neurological improvement was obtained by LP and LCS for patients with multilevel CDM, while kyphotic correction in Group LCS caused significant improvement of AS than that in Group LP. However, in a short-term postoperative follow-up, we could not demonstrate that kyphotic correction is associated with a better recovery in clinical outcomes.

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