Endoscopy-assisted anterior resection of upper cervical tumors and stability reconstruction

English Keywords:Spinal neoplasms  Atlas  Axis  Endoscope  Spinal fusion

English Abstract:

  【Abstract】 Objective：To evaluate the clinical efficacy of endoscopy-assisted anterior resection combined with posterior fixation for the treatment of upper cervical tumors.Method：From January 2006 to December 2009，8 cases（5 males，3 females） with upper cervical tumors received minimally invasive surgery in our department. The average age at admission were 35.6 years old（range，16-51 years）.The major lesion was at axis vertebral，additionally 3 cases got posterior elements and one patient had C1 anterior arch involved at the same time.The pathological diagnosis was plasma cell tumor in 3 cases，metastasis in 2 cases，osteochondroma in 1 case，eosinophilic granuloma in 1 cases and aneurysmal bone cyst in 1 case.Five patients presented with severe neck pain，other three patients had neurological deficit（according to the Frankel grade system，1 grade C，2 grade D）.All patients underwent single stage endoscopy-assisted resection of upper cervical tumors plus autograft and posterior fixation.Radiotherapy or chemotherapy was adopted postoperatively according to the pathological diagnosis.Retrospective analysis was completed in all cases.Result：No perioperative complications was observed.The average follow-up was 24 months（range，9 months to 4 years）.Solid bony fusion was confirmed by computer tomography.Three patients with neurological deficit prior surgery improved at least one level after operation.1 case with metastasis malignant died of lung cancer 11 months later after operation. Multi-level recurrence was noted in 1 patient 9 months later after operation.1 case with osteochondroma developed to multiple myeloma 17 months later.No tumor recurrence or metastasis were noted at final follow-up for the rest 5 cases.Conclusion：The technique of endoscopy-assisted anterior resection of upper cervical tumors and stability reconstruction can obviate the difficulties in exposing as well as reducing the rate of complication, however en bloc resection is technically challenging.