Document Detail

Axial spondylectomy and circumferential reconstruction via a posterior approach.
MedLine Citation:
PMID:  23149951     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Spinal metastases of the second cervical vertebra are a subset of tumors that are particularly difficult to address surgically. Previously described techniques require highly morbid circumferential dissection posterior to the pharynx for resection and reconstruction.
OBJECTIVE: To perform a biomechanical analysis of instrumented reconstruction configurations used after axial spondylectomy and to demonstrate safe use of a novel construct in a patient case report.
METHODS: Several different published and novel reconstruction configurations were inserted into 7 occipitocervical spines that underwent axial spondylectomy. A biomechanical analysis of the stiffness of the constructs in flexion and extension, lateral bending, and rotation was performed. A patient then underwent a posterior-only approach for axial spondylectomy and circumferential reconstruction.
RESULTS: Biomechanical analysis of different constructs demonstrated that anterior column reconstruction with bilateral cages spanning the C1 lateral mass to the C3 facet in combination with occipitocervical instrumentation was superior in flexion-extension and equivalent in lateral bending and rotation to currently used constructs. The patient in whom this construct was placed via a posterior-only approach for axial spondylectomy and instrumentation remained at neurological baseline and demonstrated no recurrence of local disease or failure of instrumentation to date.
CONCLUSION: When C1 lateral mass to C3 facet bilateral cage plus occipitocervical instrumentation is compared with existing anterior and posterior constructs, this novel reconstruction is biomechanically equivalent if not superior in performance. In a patient, the posterior-only approach for C2 spondylectomy with the novel reconstruction was safe and durable and avoided the morbidity of the anterior approach.
Rahul Jandial; Brandon Kelly; Brandon Bucklen; Saif Khalil; Aditya Muzumdar; Mir Hussain; Mike Y Chen
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  72     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-18     Completed Date:  2013-08-09     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  300-8; discussion 308-9     Citation Subset:  IM    
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MeSH Terms
Biomechanical Phenomena
Bone Neoplasms / secondary,  surgery*
Decompression, Surgical
Internal Fixators*
Middle Aged
Reconstructive Surgical Procedures / methods*
Sarcoma, Ewing / secondary,  surgery*
Spinal Cord / radiography,  surgery
Tomography, X-Ray Computed
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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