Single-stage total C-2 intralesional spondylectomy for chordoma with three-column reconstruction

Suchomel, Petr; Buchvald, Pavel; Barša, Pavel; Froehlich, Robert; Choutka, Ondřej; Krejzar, Zdenek; Sourkova, Petra; Endrych, Ladislav; Dzan, L.

doi:10.3171/spi.2007.6.6.17

Cited by 48 publications

(33 citation statements)

References 17 publications

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“…Since Goel et al [10] first reported a case of transoral plate and screw fixation of the clivus to the body of the cervical vertebra, several studies have been published using the clival screw fixation for the craniovertebral region [8,9]. However, the anatomy of the clivus and the geometry of the craniocervical junction present challenges for the placement of instrumentation, and also there are no literature that have document the entry point, trajectory, and optimal length of clival screws; our next logical step was to study the anatomic of clival screw fixation for the craniovertebral region.…”

Section: Discussionmentioning

confidence: 99%

“…Suchomel et al [8] created a small rightsided submandibular channel through the floor of the mouth at vertical angle via an oral surgical route for anticipated clival screws. Rawins et al [9] gained access to the anterior upper cervical spine and expose clivus through a mandibular osteotomy and soft palate split.…”

Section: Discussionmentioning

confidence: 99%

“…Also, some person shaped the head of the autogenous iliac bone into groove like for implantation, embedded in the anterior arch of the atlas, ending with anterior cervical plate (titanium plate) fixation with the lower cervical spine, so that stability was better than bone graft alone. Furthermore, Suchomel et al [8] presented a case of a chordoma treated with a single-stage total C-2 intralesional spondylectomy, and the anterior defect was reconstructed using a 14-mm diameter Harms mesh cage filled with autologous and iliac crest bone graft and then screwed into the clivus and C-3 endplate caudally. Rawlins et al [9] used a titanium plate to fix the bone graft into the clivus and the body of the 3rd cervical vertebra, as the anterior reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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The anatomic study of clival screw fixation for the craniovertebral region

Wang

et al. 2012

Eur Spine J

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Purpose To study the anatomic parameters related to clival screw and establish reference data concerning the craniovertebral fixation technique. Methods Morphometric measurement of the clivus and the surrounding anatomic structures were obtained on 41 dry bone specimens. Then, 2-D CT reconstruction of the craniovertebral region of 30 patients (19 men and 11 women, ranging in age from 20-64 years with an average age of 38.8 years) were performed to measure the safety range for a 3.5-mm screw placement. Nine entry points were evaluated. Finally, one male fresh cadaver specimen (age 46 years) was dissected to observe the craniovertebral region. Results The clivus faces the basilar artery, the V * XII cranial nerves, the pons, and ventral medulla oblongata at its intracranial surface. The longitudinal diameter of extracranial clivus was 25.87 ± 2.64 mm. The narrowest diameter of the clivus was 12.84 ± 1.08 mm, the distance between the left and right hypoglossal canal was 32.70 ± 2.09 mm at its widest part. The distance between the left and right structures, the maximum value was 49.31 ± 4.16 mm at carotid canal, the minimum value was 16.54 ± 2.04 mm at the occipital condyle. The measurement of clival screws placement simulation via 2-D CT reconstruction images shows the maximum upper insertion angle of three components the optimal entry points, the candidate points, the limit entry points was 130.19°, 125.23°and 85.72°, and the total mean screw length was 7.57, 10.13 and 15.6 mm at the vertical entry angle, respectively. Conclusions Clival screw placement is a viable option for craniovertebral fixation. There is a safe scope for the screw length and angle of the screw placement. And, these parameters obtained in the present study will be helpful for anyone contemplating the use of clival screw fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The anatomic study of clival screw fixation for the craniovertebral region

Wang

et al. 2012

Eur Spine J

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“…29 Despite the recognition that en bloc resection was ideal, cervical chordomas, particularly if located in the C1-2 segments, have largely been managed via intralesional resection, as with clival lesions. 2,12,31,32 Advancement in surgical techniques and reconstruction has permitted more of these neoplasms to be removed en bloc. 1,13,18,21,27,29,32 With the exception of a series of 5 cases published by Hsieh et al, 20 who demonstrated that wide or marginal en bloc chordoma excision was optimal for prolonging disease-free survival, the majority of literature addressing en bloc removal of cervical chordomas has been limited to reports of 3 cases or fewer.…”

mentioning

confidence: 99%

Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience

Molina

Ames

Chou

et al. 2014

SPI

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Object Chordomas involving the mobile spine are ideally managed via en bloc resection with reconstruction to optimize local control and possibly offer cure. In the cervical spine, local anatomy poses unique challenges, limiting the feasibility of aggressive resection. The authors present a multi-institutional series of 16 cases of cervical chordomas removed en bloc. Particular attention was paid to clinical outcome, complications, and recurrence. In addition, outcomes were assessed according to position of tumor at the C1–2 level versus the subaxial (SA) spine (C3–7). Methods The authors reviewed cases involving patients who underwent en bloc resection of cervical chordoma at 4 large spine centers. Patients were included if the lesion epicenter involved the C-1 to C-7 vertebral bodies. Demographic data and details of surgery, follow-up course, exposure to adjuvant therapy, and complications were obtained. Outcome was correlated with presence of tumor in C1–2 versus subaxial spine via a Student t-test. Results Sixteen patients were identified (mean age at presentation 55 ± 14 years). Seven cases (44%) cases involved C1–2, and 16 involved the subaxial spine. Median survival did not differ significantly different between the C1–2 (72 months) and SA (60 months) groups (p = 0.65). A combined (staged anteroposterior) approach was used in 81% of the cases. Use of the combined approach was significantly more common in treatment of subaxial than C1–2 tumors (100% vs 57%, p = 0.04). En bloc resection was attempted via an anterior approach in 6% of cases (C1–2: 14.3%; SA: 0%; p = 0.17) and a posterior approach in 13% of cases (C1–2: 29%; SA: 0%; p = 0.09). The most commonly reported margin classification was marginal (56% of cases), followed by violated (25%) and wide (19%). En bloc excision of subaxial tumors was significantly more likely to result in marginal margins than excision of C1–2 tumors (C1–2: 29%; SA: 78%; p = 0.03). C1–2 tumors were associated with significantly higher rates of postoperative complications (C1–2: 71%; SA: 22%; p = 0.03). Both local and distant tumor recurrence was greatest for C1–2 tumors (local C1–2: 29%; local SA: 11%; distant C1–2: 14%; distant SA: 0%). Statistical analysis of tumor recurrence based on tumor location was not possible due to the small number of cases. There was no between-groups difference in exposure to postoperative adjuvant radiotherapy. There was no difference in median survival between groups receiving proton beam radiotherapy or intensity-modulated radiotherapy versus no radiation therapy (p = 0.8). Conclusions Compared with en bloc resection of chordomas involving the subaxial cervical spine, en bloc resection of chordomas involving the upper cervical spine (C1–2) is associated with poorer outcomes, such as less favorable margins, higher rates of complications, and increased tumor recurrence. Data from this cohort do not support a statistically significant difference in survival for patients with C1–2 versus subaxial disease, but larger studies are needed to further study survival differences.

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“…27 Following en bloc chordoma resection resulting in 3-column disruption, the authors reconstructed the anterior column with a mesh cage spanning the clivus to C-3, and lateral mass cages spanning C-1 to C-3 and C-1 to C-4, supplemented with posterior instrumentation for tension banding. The authors felt that this construct would increase "surface area of potential bone fusion" and "offload the strain on the posterior occipitocervical fixation."…”

Section: Discussionmentioning

confidence: 99%

Fusion following lateral mass reconstruction in the cervical spine

Clarke

Zadnik

Groves

et al. 2015

SPI

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OBJECT Recently, aggressive surgical techniques and a push toward en bloc resections of certain tumors have resulted in a need for creative spinal column reconstruction. Iatrogenic instability following these resections requires a thoughtful approach to adequately transfer load-bearing forces from the skull and upper cervical spine to the subaxial spine. METHODS The authors present a series of 7 cases in which lateral mass reconstruction with a cage or fibular strut graft was used to provide load-bearing support, including 1 case of bilateral cage placement. RESULTS The authors discuss the surgical nuances of en bloc resection of high cervical tumors and explain their technique for lateral mass cage placement. Additionally, they provide their rationale for the use of these constructs throughout the craniocervical junction and subaxial spine. CONCLUSIONS Lateral mass reconstruction provides a potential alternative or adjuvant method of restoring the load-bearing capabilities of the cervical spine.

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Single-stage total C-2 intralesional spondylectomy for chordoma with three-column reconstruction

Cited by 48 publications

References 17 publications

The anatomic study of clival screw fixation for the craniovertebral region

The anatomic study of clival screw fixation for the craniovertebral region

Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience

Fusion following lateral mass reconstruction in the cervical spine

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