Single‑stage combined anterior retropharyngeal and posterior approach for the resection and reconstruction of 
C2 metastatic tumors: A case report

Ren,Xian‑Feng; Xi,Yong‑Ming; Zhang,Guo‑Qing; Yang,Wen‑Jiu; Zhang,Xu; Yang,De‑Ling; Hu,You‑Gu

doi:10.3892/etm.2014.1493

Single‑stage combined anterior retropharyngeal and posterior approach for the resection and reconstruction of C2 metastatic tumors: A case report

Authors:
- Xian‑Feng Ren
- Yong‑Ming Xi
- Guo‑Qing Zhang
- Wen‑Jiu Yang
- Xu Zhang
- De‑Ling Yang
- You‑Gu Hu
View Affiliations

Affiliations: Department of Orthopedic Surgery, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong 266003, P.R. China
Published online on: January 21, 2014 https://doi.org/10.3892/etm.2014.1493
Pages: 887-890

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

This study reports the case of a 44‑year‑old male who had experienced severe neck pain for one month and was diagnosed with a metastatic tumor of the left C2 vertebral body and the left transverse process. The tumor was distributed to layers A‑D and sectors 3‑7 according to the Weinstein‑Boriani‑Biagini classification, and was in Category IV according to the Harrington classification system. A conventional posterior cervical approach was used to resect the left transverse process and part of the tumor in a piecemeal fashion, and spinal instrumentation was also performed. Gelfoam and absorbable hemostatic gauze were placed ventrally to the left vertebral artery and the left C3 nerve root over the tumor bed to prevent their accidental injury in the subsequent anterior approach. A high anterior retropharyngeal approach was then used to resect the tumorous C2 vertebral body by corpectomy and to perform anterior reconstruction. Six months after the surgery, the patient remained pain free. Therefore, C2 metastatic tumor resection and spinal reconstruction can be fulfilled by a single‑stage combined high anterior retropharyngeal and posterior approach.

View Figures

View References

1	Laufer I, Sciubba DM, Madera M, Bydon A, Witham TJ, Gokaslan ZL and Wolinsky JP: Surgical management of metastatic spinal tumors. Cancer Control. 19:122–128. 2012.PubMed/NCBI
2	Harrington KD: Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg. 61:107–117. 1984. View Article : Google Scholar : PubMed/NCBI
3	Hsu W, Wolinsky JP, Gokaslan ZL and Sciubba DM: Transoral approaches to the cervical spine. Neurosurgery. 66(Suppl 3): 119–125. 2010. View Article : Google Scholar : PubMed/NCBI
4	Logroscino CA, Casula S, Rigante M and Almadori G: Transmandibular approach for the treatment of upper cervical spine metastatic tumors. Orthopedics. 27:1100–1103. 2004.PubMed/NCBI
5	Smith GW and Robinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 40-A:607–624. 1958.PubMed/NCBI
6	McAfee PC, Bohlman HH, Riley LH Jr, Robinson RA, Southwick WO and Nachlas NE: The anterior retropharyngeal approach to the upper part of the cervical spine. J Bone Joint Surg Am. 69:1371–1383. 1987.PubMed/NCBI
7	Laus M, Pignatti G, Malaguti MC, Alfonso C, Zappoli FA and Giunti A: Anterior extraoral surgery to the upper cervical spine. Spine (Phila Pa 1976). 21:1687–1693. 1996. View Article : Google Scholar : PubMed/NCBI
8	Boriani S, Weinstein JN and Biagini R: Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976). 22:1036–1044. 1997. View Article : Google Scholar : PubMed/NCBI
9	Harrington KD: Metastatic disease of the spine. J Bone Joint Surg Am. 68:1110–1115. 1986.
10	Balasingam V, Anderson GJ, Gross ND, et al: Anatomical analysis of transoral surgical approaches to the clivus. J Neurosurg. 105:301–308. 2006. View Article : Google Scholar : PubMed/NCBI
11	Rhines LD, Fourney DR, Siadati A, Suk I and Gokasla ZL: En bloc resection of multilevel cervical chordoma with C-2 involvement. Case report and description of operative technique. J Neurosurg Spine. 2:199–205. 2005. View Article : Google Scholar : PubMed/NCBI
12	Konya D, Ozgen S, Gerçek A, Celebiler O and Pamir MN: Transmandibular approach for upper cervical pathologies: report of 2 cases and review of the literature. Turk Neurosurg. 18:271–275. 2008.PubMed/NCBI
13	Fong S and DuPlessis SJ: Minimally invasive anterior approach to upper cervical spine: surgical technique. J Spinal Disord Tech. 18:321–325. 2005. View Article : Google Scholar : PubMed/NCBI
14	Yang X, Wu Z, Xiao J, et al: Sequentially staged resection and 2-column reconstruction for C2 tumors through a combined anterior retropharyngeal-posterior approach: surgical technique and results in 11 patients. Neurosurgery. 69(2 Suppl Operative): ons184–ons194. 2011.
15	Melcher RP and Harms J: Biomechanics and materials of reconstruction after tumor resection in the spinal column. Orthop Clin North Am. 40:65–74. 2009. View Article : Google Scholar : PubMed/NCBI
16	Deshmukh VR, Fiorella DJ, Albuquerque FC and McDougall CG: Embolization techniques for neoplasms of the spine and spinal cord. Spinal Cord and Spinal Column Tumors: Principles and Practice. Dickman CA, Fehlings MG and Gokaslan ZL: Thieme Medical Publishers, Inc; New York, NY: pp. 204–213. 2006
17	Eleraky M, Setzer M and Vrionis FD: Posterior transpedicular corpectomy for malignant cervical spine tumors. Eur Spine J. 19:257–262. 2010. View Article : Google Scholar : PubMed/NCBI
18	Colak A, Kutlay M, Kibici K, Demircan MN and Akin ON: Two-staged operation on C2 neoplastic lesions: anterior excision and posterior stabilization. Neurosurg Rev. 27:189–193. 2004. View Article : Google Scholar : PubMed/NCBI