TY - JOUR
T1 - Posterior Nerve–Sparing Multilevel Cervical Corpectomy and Reconstruction for Metastatic Cervical Spine Tumors
T2 - Case Report and Literature Review
AU - Shaaya, Elias
AU - Fridley, Jared
AU - Barber, Sean M.
AU - Syed, Sohail
AU - Xia, Jimmy
AU - Galgano, Michael
AU - Oyelese, Adetokunbo
AU - Telfeian, Albert
AU - Gokaslan, Ziya
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Background: Cervical spine metastases with circumferential spinal cord compression often are treated with combined anteroposterior decompression and stabilization. In patients with large anterior neck masses, previous radiotherapy to the neck, or previous anterior neck surgery, however, anterior approaches may pose additional risk. In such cases, posterior-only approaches that allow for circumferential decompression and anterior column reconstruction may be beneficial. Case Description: We present the case of a 70-year-old man with follicular thyroid carcinoma metastatic to the cervical spine causing spinal cord compression. We used a posterior-only approach for a C6–C7 partial corpectomy and posterior decompression and fusion from C2 to T2. Our technique involved preoperative embolization of the right vertebral artery to safely gain access to the ventral surface of the spinal cord and vertebral bodies. Anterior column support was provided by a chest tube/polymethylmethacrylate construct, allowing the implant to be placed within the anterior column from a posterior approach without nerve root sacrifice. The patient tolerated the procedure well. He had no postoperative neurologic deficits. Two months later, he underwent a total thyroidectomy followed by stereotactic radiotherapy to the tumor bed (2700 cGy total, 3 fractions). At 1-year follow-up, he was active and without significant pain or focal neurologic deficits. Conclusions: We propose a novel approach to ventral/circumferential cervical spine tumors that combines epidural decompression and cervical stabilization via a posterior-only approach. By using a chest tube/polymethylmethacrylate construct, anterior column support can be achieved through a posterior approach without nerve root sacrifice.
AB - Background: Cervical spine metastases with circumferential spinal cord compression often are treated with combined anteroposterior decompression and stabilization. In patients with large anterior neck masses, previous radiotherapy to the neck, or previous anterior neck surgery, however, anterior approaches may pose additional risk. In such cases, posterior-only approaches that allow for circumferential decompression and anterior column reconstruction may be beneficial. Case Description: We present the case of a 70-year-old man with follicular thyroid carcinoma metastatic to the cervical spine causing spinal cord compression. We used a posterior-only approach for a C6–C7 partial corpectomy and posterior decompression and fusion from C2 to T2. Our technique involved preoperative embolization of the right vertebral artery to safely gain access to the ventral surface of the spinal cord and vertebral bodies. Anterior column support was provided by a chest tube/polymethylmethacrylate construct, allowing the implant to be placed within the anterior column from a posterior approach without nerve root sacrifice. The patient tolerated the procedure well. He had no postoperative neurologic deficits. Two months later, he underwent a total thyroidectomy followed by stereotactic radiotherapy to the tumor bed (2700 cGy total, 3 fractions). At 1-year follow-up, he was active and without significant pain or focal neurologic deficits. Conclusions: We propose a novel approach to ventral/circumferential cervical spine tumors that combines epidural decompression and cervical stabilization via a posterior-only approach. By using a chest tube/polymethylmethacrylate construct, anterior column support can be achieved through a posterior approach without nerve root sacrifice.
KW - Cervical spine reconstruction
KW - Polymethylmethacrylate
KW - Posterior cervical corpectomy
KW - Spine metastasis
KW - Spine tumor
KW - Thyroid carcinoma
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UR - http://www.scopus.com/inward/citedby.url?scp=85057542249&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2018.11.010
DO - 10.1016/j.wneu.2018.11.010
M3 - Article
C2 - 30447451
AN - SCOPUS:85057542249
SN - 1878-8750
VL - 122
SP - 298
EP - 302
JO - World neurosurgery
JF - World neurosurgery
ER -