Complications of total spondylectomy of upper cervical spine primary tumor

English Keywords:Spine tumor  Spondylectomy  Complication  Upper cervical spine  Surgery  Surgical approach

English Abstract:

  【Abstract】 Objectives: To summarize the intra-and post-operative complications of the total spondylectomy of the upper cervical spine primarty tumor in order to make the surgery safer and improve the outcomes. Methods: 23 cases with upper cervical primary tumor underwent total intralesional spondylectomy from March 2005 to July 2013. 12 males and 11 females were included with a mean age of 39 year(17-70 years). The defects included C2 in 11 patients, C1 to C2 in 2 patients, and C2 to C3 in 10 patients. Preoperative and postoperative histology results were same in 21 patients, which included 10 chordomas, 2 chondrosarcomas, 7 giant cell tumors, 1 malignant nerve sheath tumor and 1 osteoblastoma. 2 patients showed different histology results before and after the surgery. Preoperative osteoblastoma under biopsy turned out to be fibrous dysplasia after operation in 1 patient. Preoperative giant cell tumor turned out to be low-grade malignant spindle cells tumor in the other patient. Combined anterior and posterior approaches were performed including anterior-posterior procedure in 11 cases and posterior-anterior procedure in 12 cases. 3 types of anterior approaches including transmandibular approach in 3 patients, transoral approach in 11 patients and high retropharyngeal approach in 9 patients were performed. Anterior reconstructions were also carried out in 3 different ways, including plate and iliac crest strut graft in 4 patients, plate and mesh cage in 4 patients, and Harms mesh cage alone in 15 patients. Posterior occipitocervical fixations were carried out in all patients. Halo-vest was all used routinely. Results: Intraoperative complications occurred in 8 patients, which included one side vertebral artery injuries in 5 patients, spinal cord injury in 1 patient, dura tear in 2 patients, and superior laryngeal nerve injury in 2 patient. Postoperative complications occurred in 12 patients, which included one death of respiratory failure due to mesh cage dislocation, one death of oral wound delayed bleeding, and vertebral artery injury in 1 patient, wound infection in 6 patients, non-healing or delayed-healing of oral mucosa in 8 patients, pneumonia in 4 patients, and upper gastrointestinal bleeding in 1 patient. Failure of fusion was found in 3 patients, bone graft absorbed and hardware loosening in 5 patients and malpositional fusion in 3 patients. Conclusions: Upper cervical spondylectomy is a demanding surgery with high rate of perioperative complications. The complications mainly included intraoperative vertebral artery injuries, instrument failure and pharyngeal infections.