Application of atypical titanium mesh in stability reconstruction after upper-middle cervical lesion resection

English Keywords:Upper cervical spine  Titanium mesh  Vertebral body reconstruction

English Abstract:

  【Abstract】 Objectives: To explore the application of atypical titanium mesh in stability reconstruction after upper-middle cervical lesion resection. Methods: From June 2004 to June 2010, ten patients with ventral lesion involving the upper-middle cervical spine undergoing surgery were reviewed retrospectively. Of all patients, two had old tuberculosis, five had primary tumors, and three had metastasis. Two cases had C2 involved, seven had C2 and C3 involved, and one had C2-C4 involved. The average preoperative JOA score was 10(range 7-14). The preoperative X-ray, CT and MRI images of each patient were obtained. Under general anesthesia and according to the lesion sites, four cases underwent transoral approach, and the other six cases underwent transoral-transabiomandibular approach. Anterior lesions resection and reconstruction with atypical mesh was used in all patients, meanwhile one-stage posterior instrumentation was applied. Five cases had C1-2 instrumentation(C1-C3 in 2, C1-4 in 3), and five cases had occipital-cervical instrumentation (C0-C4 in 1, C0-C5 in 2 and C0-C6 in 2). Postoperative complications, bony fusion and JOA scores were observed at follow-up. Results: Ventral resections of the lesions and decompressions were completed successfully in all patients, with the operative time ranging from 5 to 8 hours and blood loss ranging from 500ml to 3000ml. No cerebrospinal fluid leakage, neural or vascular injury was noted. Nine cases were followed up for 3 to 14 months(average, 8 months). The clinical symptoms improved significantly with a mean JOA score of 14. A solid bone fusion confirmed by CT scan was observed at final follow-up. No postoperative complications such as internal failure and wound infection were found during the follow-up. Conclusions: Anterior atypical titanium mesh can be used to reconstruct the vertebral body, and a combined posterior instrumentation can ensure reliable upper-middle cervical stability.