Surgical treatment of tumors involving the cervicothoracic junction

2003 ◽  
Vol 15 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Hoang Le ◽  
Raju Balabhadra ◽  
Jon Park ◽  
Daniel Kim
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Effective Treatment ◽  
Neurological Status ◽  
Cord Compression ◽  
Surgical Approaches ◽  
Surgical Experience ◽  
Cervicothoracic Junction ◽  
High Propensity ◽  
Polyaxial Screws

Object Tumors involving the cervicothoracic junction can have a high propensity for causing instability, with kyphosis and spinal cord compression resulting. Treatment with decompression only can lead to further instability and worsening neurological status. In this article, the authors review their surgical experience in the treatment of 19 patients with tumors involving the cervicothoracic junction. The various approaches and instrumentation techniques involved in decompression and stabilization of the cervicothoracic junction are also reviewed. Methods Aggressive instrumentation-augmented fusion after decompression of the cervicothoracic region can provide for immediate stabilization and early rehabilitation. Recent development of new hardware such as dual-diameter transition rods, polyaxial screws, and interlocking devices have enhanced the ability to fashion a strong construct for stabilization of the cervicothoracic junction. Conclusions Familiarity with complex instrumentation techniques and various surgical approaches to the cervicothoracic junction will be required for effective treatment of tumors causing instability of this region.

Cranial thoracic vertebral canal stenosis in three juvenile large-breed brachycephalic dogs treated by unilateral hemilaminectomy

2017 ◽  
Vol 30 (03) ◽  
pp. 223-229 ◽  
Author(s):  
Andrew Marchevsky ◽  
Amanda Miller
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Case Series ◽  
Neurological Status ◽  
Cord Compression ◽  
Vertebral Canal ◽  
Neurological Signs ◽  
Canal Stenosis ◽  
Spinal Cord Segment ◽  
Independent Ambulation

SummaryObjective: To describe the surgical treatment and outcome for juvenile dogs with cranial thoracic vertebral canal stenosis treated by unilateral hemilaminectomy.Study design: Case series.Animals: Three large-breed brachycephalic dogs of various breeds (Dogue de Bordeaux, Australian Bulldog, Boerboel) with neurological signs consistent with a myelopathy of the third thoracic (T) to third lumbar (L) spinal cord segment.Methods: Information on clinical presentation, diagnostic imaging, surgical procedures, postoperative complications, recovery and outcome is described.Results: Neurological signs were present and progressive for two to four weeks prior to surgery and ranged from mild ataxia to paralysis. Cranial thoracic vertebral canal stenosis was diagnosed with computed tomography imaging. Lateral and dorsolateral spinal cord compression was present at multiple sites between T2 and T6. Alternating left and right-sided compressions were common. Surgical treatment was by unilateral, continuous hemilaminectomy over three to six vertebral spaces. Postoperative morbidity was minimal and return of independent ambulation was rapid (median: 13.5 days, range: 2–29 days). Neurological status in one dog worsened four months after surgery due to reoccurrence of osseous compression; unilateral hemilaminectomy was repeated in this dog. Long-term follow-up ranged from six to 10 months; neurological signs had completely resolved in one dog and substantially improved in the other two dogs.Clinical significance: Unilateral hemilaminectomy was associated with rapid return of independent ambulation and substantial improvement in neurological scores.

scholarly journals Anterior surgical management of the cervicothoracic junction lesions at T1 and T2 vertebral bodies

2008 ◽  
Vol 66 (2a) ◽  
pp. 199-203 ◽  
Author(s):  
Asdrubal Falavigna ◽  
Orlando Righesso ◽  
Darcy Ribeiro Pinto-Filho ◽  
Alisson Roberto Teles
Keyword(s):  
Surgical Treatment ◽  
Surgical Approaches ◽  
Cervicothoracic Junction ◽  
High Propensity ◽  
Transmanubrial Approach ◽  
Vertebral Bodies ◽  
T1 And T2 ◽  
Cervical Plate ◽  
Anterior Reconstruction ◽  
Plate System

Lesions of the cervicothoracic junction have a high propensity for causing instability and present unique challenges in the surgical treatment. Several surgical approaches to this region have been described in the literature. We report our experience in the surgical treatment of six patients with unstable lesions involving the cervicothoracic junction at T1 and T2 vertebral bodies. The patients underwent an anterior left Smith-Robinson approach and manubriotomy. Mesh and cervical plate system were used for stabilization and reconstruction of the region. No complication related to the surgical procedure was observed. In our experience, in injuries involving the T1 and T2 vertebral bodies, the transmanubrial approach offers good working room to remove the lesions and anterior reconstruction.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Intramedullary inclusion cysts of the cervicothoracic junction

2007 ◽  
Vol 7 (2) ◽  
pp. 236-242 ◽  
Author(s):  
Alfred T. Ogden ◽  
Alexander G. Khandji ◽  
Paul C. McCormick ◽  
Michael G. Kaiser
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Surgical Treatment ◽  
Dermoid Cyst ◽  
Clinical Features ◽  
Epidermoid Cyst ◽  
Relevant Literature ◽  
Literature Discussion ◽  
Cervicothoracic Junction

✓Intramedullary inclusion cysts are extremely rare within the rostral spinal cord. In this case report the authors outline the clinical features and surgical treatment of one dermoid cyst and one epidermoid cyst of the cervicothoracic junction. The authors also include a relevant literature discussion regarding the treatment and the embryological origin of these lesions.

scholarly journals Thoracic Vertebral Hemangioma with Spinal Cord Compression: Multidisciplinary Surgical Treatment and Follow-up of Six Patients

2016 ◽  
Vol 8 (4) ◽  
pp. 462-467 ◽  
Author(s):  
Hui-lin Zhang ◽  
Yong-cheng Hu ◽  
Rajendra Aryal ◽  
Xin He ◽  
Deng-xing Lun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Vertebral Hemangioma

Surgical Treatment of Spinal Cord Compression in Patients with Lung Cancer

Neurosurgery ◽  
1985 ◽  
Vol 16 (3) ◽  
pp. 350-356 ◽  
Author(s):  
Narayan Sundaresan ◽  
Manjit Bains ◽  
Patricia McCormack
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Surgical Treatment ◽  
Cord Compression ◽  
Radiological Findings ◽  
Tissue Mass ◽  
Direct Extension ◽  
In Series ◽  
Iridium 192 ◽  
Localized Disease

Abstract We analyzed the clinical features, radiological findings, and results of surgical treatment in series of 25 patients with lung cancer and invasion of the spine. In 12 of the 25 (40%) patients, involvement of the spine was present at the time of initial presentation of malignancy. Computed tomography revealed the presence of a large paravertebral soft tissue mass with destruction of adjacent ribs in the majority. The surgical approach consisted of an anterolarteral exposure through a formal thoracotmy in 22 patients and a thoracobadominal flank approach in the 3 patients with lumbar lesions. All gross tumor was resected from the involved paravertebral tissues, vertebral body, and epidural space. Immediate stabilization of the spine was then achieved with methyl methacrylate. Local brachytherapy (iridium-192 implants) was used in 19 patients. After treatment, 87% were ambulatory, and 67% maintained ambulation for more than6 months. Our data suggest that compression of the spinal cord in many patients with lung cancer results from direct extension of tumor through the chest wall. Because the majority of such patients often have localized disease involving the spine, aggressive surgical treatment is indicated.

Are they too old? Surgical treatment for metastatic epidural spinal cord compression in patients aged 65 years and older

2014 ◽  
Vol 36 (6) ◽  
pp. 530-543 ◽  
Author(s):  
Eyal Itshayek ◽  
Omer Or ◽  
Leon Kaplan ◽  
Josh Schroeder ◽  
Yair Barzilay ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Spinal Cord Compression ◽  
Cord Compression

Thoracoscopic transdiaphragmatic approach for ventral decompression and reconstruction of metastatic spine disease

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Vertebral Body Replacement ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Minimal Incision ◽  
Spine Disease ◽  
Treatment Surgery

The management of metastatic spine disease is complex, but usually involves radiation therapy and/or surgical treatment. Surgery followed by radiation has a significant role in select patients presenting with metastatic spinal cord compression. Ventral decompression can be achieved through several surgical approaches including posterior, posterolateral, and anterior surgical approaches. Although open thoracotomy is the most common approach for ventral decompression, it is associated with significant spinal access morbidity. This video illustrates a thoracoscopic transdiaphragmatic approach for symptomatic L-1 metastatic spinal cord compression. This approach allows for a minimal incision in the diaphragm to expose the thoracolumbar junction and allows for corpectomy, spinal canal decompression, vertebral body replacement, and spinal stabilization via four small incisions along the chest wall. The step-by-step technique illustrates operative nuances and surgical pearls to safely perform this approach in a patient with thoracolumbar L-1 metastatic spinal cord compression. The video can be found here: http://youtu.be/w8fanV9bq-E.

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