Total spondylectomy for C2 chordoma in recent twenty years: evaluation of surgical techniques

Abstract

Objective To evaluate the outcomes of the patients treated with different surgical procedures of total spondylectomy for C2 chordoma. Methods Data of 20 patients with C2 chordoma treated in Peking University Third Hospital from January 1996 to July 2014 were retrospectively analyzed. The axis had been destroyed by chordoma invasion at the diagnosis. The unilateral vertebral artery was involved in 14 cases and bilateral vertebral artery involved in 6 cases. Total spondylectomy of C2 was achieved by posterior combined with anterior surgical procedures. All patients had received radiotherapy. The differences of blood loss, operative time, complications, recurrence and mortality rates between one stage and two-stage or the two kinds of surgical procedures were compared. Results The follow-up period of twenty cases was from 14 to 176 months. 12 patients underwent onestage surgery. Two patients with Frankel C had improved to D; three of four patients with Frankel D had improved to E, and the other one had no change after operation. The mean operation time was 9.9±1.2 h with 3 325.0±1 015.4 ml of blood loss. The recurrence rate was 72.7% and mortality rate was 58.3%. 5 years disease-free survival rate was 36% and 5 years total survival rate was 45%. 8 patients underwent two-stage surgery. Two patients with Frankel D had improved to E after operation. The mean operation time was 10.7±2.7 h with 2 787.5±1 698.3 ml of blood loss. The recurrence rate was 28.6% and mortality rate was 53.8%. 5 years disease-free survival rate was 51% and 5 years total survival rate was 69%. 13 patients underwent surgery by an anterior approach combined with posterior approach. The mean operation time was 10.0±1.4 h with 3 533.0±901.8 ml of blood loss. The recurrence rate was 75% and mortality rate was 37.5%. 5 years disease-free survival rate was 33% and 5 years total survival rate was 50%. 7 patients underwent surgery by a posterior approach combined with anterior approach. The mean operation time was 10.6±2.7 h with 2 475.0±1 629.9 ml of blood loss. The follow up period was from 12 to 64 months. The recurrence rate was 16.7% and mortality rate was 42.9%. 5 years disease-free survival rate was 67% and 5 years total survival rate was 50%. The recurrence rate of the patients with posterior approach combined with anterior approach (16.7%) was significantly lower than that of anterior approach combined with posterior approach (75%). However, the rate of transoral approach in the patients (62.5%) was higher than that of anterior approach combined with posterior approach (25%). There was no significant difference in the operative time, blood loss and other complications. Conclusion A two-stage operation has replaced the one-stage operation, and the surgical procedures are converted from the anterior combined with posterior approaches to the posterior combined with anterior approaches. The posterior combined with anterior approach can minimize the recurrence rate; however, the rate of transoral approaches is increased in the second stage. Key words: Axis; Chordoma; Surgical procedures, operative