C2 全脊椎切除术的技术问题。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Journal of neurosurgical sciences Pub Date : 2024-02-01 Epub Date: 2023-01-27 DOI:10.23736/S0390-5616.21.05443-6
Jan Stulik, Zdenek Klezl, Michal Varga, Tomas Vyskocil
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引用次数: 0

摘要

背景:第二颈椎肿瘤是一种不常见但严重的疾病。原发性肿瘤和单发转移瘤可以通过根治性手术,即完全切除整个椎间隙来解决。第二颈椎的解剖结构非常复杂,手术需要相当高的手术技巧。本回顾性研究旨在介绍因肿瘤适应症而进行C2椎体全切除术的技术要点、本组患者的临床和放射学评估,以及与近期文献中有关该区域手术的报道结果进行比较:2006年至2019年期间,我们科室为原发性骨肿瘤或单发转移瘤进行了10例C2全切手术。4例因脊索瘤而手术,1例因其他诊断(浆细胞瘤、EWSA、甲状腺乳头状癌转移、甲状腺髓样癌、肺癌和鼻窦癌)而手术。所有病例的手术均分两步进行。手术总是从后路开始。根据患者的情况,前路手术平均间隔 16.9 天(7-21 天不等):结果:所有患者的上颈椎都很稳定。结果:所有患者的上颈椎均保持稳定,所有在世患者的整个器械上都有坚实的骨融合,并恢复到术前的活动水平。在最后的随访中,6 名患者死亡:1 名患者死于术后第 5 天,原因是手术伤口出现无法控制的弥漫性出血;3 名患者死于潜在疾病的全身扩散;2 名患者死于与疾病局部复发相关的并发症。除定期随访外,还在研究结束时,即术后平均 91 个月(17-179 个月)对存活患者(4 人)进行了检查。除去一名早期死亡的患者,死亡患者的平均随访时间为 34.6 个月(9-55 个月)(N.=5)。整组患者的平均随访时间为 59.7 个月(9 人):C2椎体全切除术是一种特殊的外科手术,存在严重并发症的风险,但能为患者提供完全康复的机会。即使在目前的成像和其他检测水平下,准确界定适应症,尤其是单发转移瘤的适应症也非常困难。在我们的研究中,长期存活患者的生活质量并未受到明显影响。
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Technical aspects of total spondylectomy of C2.

Background: Tumorous involvement of the second cervical vertebra is an infrequent, but severe disease. Primary tumors and solitary metastases can be addressed by a radical procedure, a complete removal of the whole compartment. The second cervical vertebra has a highly complex anatomy, and its operation requires considerable surgical skills. The aim of this retrospective study is to present technical aspects of complete resection of C2 for tumor indications, clinical and radiological evaluation of our group of patients and comparison of results of recent reports on surgery in this region in the literature.

Methods: Between 2006 and 2019 we performed 10 total resections of C2 for primary bone tumor or solitary metastasis at our department. Operation was indicated for chordoma in 4 cases and for other diagnoses (plasmacytoma, EWSA, metastases of papillary thyroid carcinoma, medullary thyroid carcinoma, lung carcinoma and sinonasal carcinoma) in one case each. The operative procedure was in all cases performed in two steps. It always started with the posterior approach. The anterior procedure was scheduled according to the patient's condition after an average interval of 16.9 days (range 7-21).

Results: A stable upper cervical spine was achieved in all patients. A solid bone fusion over the whole instrumentation was present in all living patients and they returned to their preoperative activity level. By the final follow-up 6 patients died: one patient died on the 5th postop day because of diffuse uncontrollable bleeding from surgical wound, three patients died of generalization of the underlying disease and two patients due to complications associated with local recurrence of the disease. In addition to regular follow-ups, the surviving patients (N.=4) were also examined upon completion of the study, i.e., on average 91 months (range 17-179 months) postoperatively. With exclusion of an early deceased patient, the average follow-up period of deceased patients was 34.6 months (range 9-55) (N.=5). The average follow-up of the whole group of patients was 59,7 months (N.=9).

Conclusions: Total spondylectomy of C2 is an exceptional surgical procedure associated with risk of serious complications but offers chance for a complete recovery of the patient. Defining indications accurately, especially in solitary metastases, is very difficult even with current level of imaging and other testing. The quality of life of long-term surviving patients in our study was not significantly impacted.

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来源期刊
Journal of neurosurgical sciences
Journal of neurosurgical sciences CLINICAL NEUROLOGY-SURGERY
CiteScore
3.00
自引率
5.30%
发文量
202
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Sciences publishes scientific papers on neurosurgery and related subjects (electroencephalography, neurophysiology, neurochemistry, neuropathology, stereotaxy, neuroanatomy, neuroradiology, etc.). Manuscripts may be submitted in the form of ditorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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