C3 Corpectomy Research Articles

In vivo study of a novel 3D-printed motion-preservation artificial cervical corpectomy construct: short-term imaging and biocompatibility evaluations in a goat model

BackgroundNonfusion technologies, such as motion-preservation devices, have begun a new era of treatment options in spine surgery. Motion-preservation approaches mainly include total disc replacement for anterior cervical discectomy and fusion. However, for multisegment fusion, such as anterior cervical corpectomy and fusion, the options are more limited. Therefore, we designed a novel 3D-printed motion-preservation artificial cervical corpectomy construct (ACCC) for multisegment fusion. The aim of this study was to explore the feasibility of ACCC in a goat model.MethodsGoats were treated with anterior C3 corpectomy and ACCC implantation and randomly divided into two groups evaluated at 3 or 6 months. Radiography, 3D CT reconstruction and MRI evaluations were performed. Biocompatibility was evaluated using micro-CT and histology.ResultsPostoperatively, all goats were in good condition, with free neck movement. Implant positioning was optimal. The relationship between facet joints was stable. The range of motion of the C2-C4 segments during flexion–extension at 3 and 6 months postoperatively was 7.8° and 7.3°, respectively. The implants were wrapped by new bone tissue, which had grown into the porous structure. Cartilage tissue, ossification centres, new blood vessels, and bone mineralization were observed at the porous metal vertebrae-bone interface and in the metal pores.ConclusionsThe ACCC provided stabilization while preserving the motion of the functional spinal unit and promoting bone regeneration and vascularization. In this study, the ACCC was used for anterior cervical corpectomy and fusion (ACCF) in a goat model. We hope that this study will propel further research of motion-preservation devices.

Case Report: Langerhans cell histiocytosis involving the cervical spine in an adult patient

Langerhans Cell Histiocytosis (LCH) is a typically benign disorder that affects infants predominately, with adult occurrence being uncommon. We discuss the case of a 22-year-old guy who visited our clinic complaining of three months of acute nape pain and upper limb radiculopathy. Notably, the patient had no history of trauma, fall injuries, or tuberculosis. Radiological tests identified a single osteolytic lesion within the C3 vertebral body. The lesion was removed, an anterior C3 corpectomy and discectomy were performed, and the patient's spine was reconstructed with a titanium cage and plating. The patient's nape discomfort and radiculopathy vanished almost instantly after surgery. A definitive diagnosis of LCH was confirmed through histological examination. This case report illustrates the unusual and uncommon occurrence of LCH at the C3 vertebral body, for which fusion surgery was the only viable therapeutic option. The patient's recovery from radiating pain following the surgical procedure demonstrates the effectiveness of the intervention. LCH in the cervical spine is rather rare, but it is nevertheless important to be aware of the possibility of developing it.

P116. Upper cervical corpectomy: Outcomes and complications

<h3>BACKGROUND CONTEXT</h3> Given the rare indications, upper cervical corpectomy of the C3 and/or C4 region is an uncommon procedure. The complex anatomy of the upper cervical spine can make exposure and corpectomy of this region technically challenging. There are several case reports of upper cervical corpectomy within the literature. However, there are few case series including the results of upper cervical corpectomy, and to the authors' knowledge, none exclusively report the outcomes and complications of corpectomy at the C3 and/or C4 level. In addition, a previous study within the literature demonstrated that patients with corpectomy involving the C4 vertebral body (alone or as part of multilevel corpectomy) were significantly more likely to suffer complications. <h3>PURPOSE</h3> The purpose of this study is to describe our tertiary referral center's outcomes and complications following upper cervical corpectomy. The authors hypothesized that upper cervical corpectomy is associated with a greater propensity for complications considering the complex anatomy of this region. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series. <h3>PATIENT SAMPLE</h3> All patients undergoing anterior cervical spine procedures by the senior author from 11/2012 to 10/2020 at a level I trauma center and regional cancer center were identified. <h3>OUTCOME MEASURES</h3> Length of hospital stay, estimated blood loss (EBL), discharge disposition, intraoperative complications, perioperative complications, and Neck Disability Index (NDI) scores. <h3>METHODS</h3> Patients undergoing C3 and/or C4 corpectomies with a follow-up of greater than 6 months were enrolled. Demographic information, diagnoses, ASIA grade, surgical data, complications, and NDI scores were collected. <h3>RESULTS</h3> A total of 247 patients undergoing anterior cervical procedures were identified. Ten of 247 (4%) underwent upper cervical corpectomies. Four out of 10 (40%) had a C3 corpectomy, 1 out of 10 (10%) had C3 and C4 corpectomies, 3 out of 10 (30%) had a C4 corpectomy and 2 out of 10 (20%) had C4 and C5 corpectomies. Mesh cages were used in 9/10 cases and fibula strut allograft used in one case. The average age was 55.5 years. (16-76 years), and there were 6 males and 4 females. Diagnoses were: 3 tumors, 3 fractures, 2 cervical spondylotic myelopathy (CSM), 1 central cord syndrome and 1 epidural abscess. Six of 10 procedures were performed emergently due to neurological deficits or instability. ASIA grade was: E (7), D (2), and B (1). An average of 3 levels were fused with an average EBL of 225 ml (25ml – 800ml). Average hospital stay was 12.25 days, and 4 of 10 patients were discharged to rehabilitation. There were no intraoperative complications. There were 4 patients with postoperative complications, including fibula strut graft dislodgement (n=1, 10%), temporary facial nerve neuropraxia (n=1, 10%), seroma (n=1, 10%), hematoma (n=1, 10%), PEG tube placement (n=1, 10%), and systemic complications (n=4, 40%, ie, pulmonary embolism, pneumonia, C. difficile colitis, respiratory failure). Of the 10 patients included, 9 had NDI surveys completed at their latest follow-up at least 6 months postoperatively. The average latest follow-up visit was 21.1 months, and the mean NDI score at the latest clinic visit was 15.7. <h3>CONCLUSIONS</h3> In this case series, cervical corpectomy at the level of C3 and/or C4 was performed in patients with tumors, fractures and myelopathy, and demonstrated a surgical complication rate of 40%. Upper cervical corpectomy is uncommon, sparsely reported, and demonstrated high rates of complications; these findings may help guide clinician management and patient expectations of upper cervical corpectomy. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Association Between C5 Palsy and the Anterior Decompression Procedures, Corpectomy and Discectomy.

This is a retrospective study. The aim was to evaluate the influence of various decompression procedures on the incidence of C5 palsy (C5P). C5P is a well-known but unsolved complication of cervical spine surgery. Among anterior cervical decompressive procedures, both corpectomy and discectomy are important surgical methods, whose effects on the incidence of C5P are unknown. We retrospectively analyzed 818 patients (529 men; mean age: 59.2±11.6 y) who underwent anterior cervical decompression and fusion. The surgical choice to use corpectomy, discectomy, or hybrid decompression was based on standard treatment strategies depending on local compressive pathology and presenting clinical symptoms. We introduced an original "decompression combination score" as a means of quantifying the effects of the procedures on the development of C5P. The scores were based on the relative severity of various risk factors associated with the eventual development of C5P and were assigned as follows: C4 corpectomy, 1 point; C5 corpectomy, 1 point; C3 corpectomy successive to C4 corpectomy, 0.5 point; C6 or C7 corpectomy successive to C5 corpectomy, 0.5 point; C4/5 discectomy, 0.5 point; discectomy at another segment, 0 point. Each patient's decompression combination score was then comprised of the sum of these points. C5P occurred in 55 (47 men, mean age: 65.7±8.7 y) of the 818 (6.7%) patients. A larger number of operated disc segments was significantly associated with C5P. Higher decompression combination score was significantly associated with C5P. Multivariate analysis revealed that male sex, higher decompression combination score, and older age were significant risk factors. Corpectomy increased the incidence of C5P, while discectomy decreased the risk. The lower incidence of postoperative C5P after discectomy may be because of minimizing tethering effect to the C5 nerve root. As a preventive measure against C5P, corpectomy should be avoided, while discectomy is recommended as much as possible. Levels of Evidence: Step IV-Oxford Center for Evidence-Based Medicine 2011.

Posterior Surgical Approach for Ventral Cervical Spinal Cord Herniation: 2-Dimensional Operative Video.

Spinal cord herniation (SCH) is a rare condition that is typically of idiopathic origin. Although SCH is mostly found in the thoracic region because of a dural defect, there are some reports of cervical SCH following surgery or trauma.1-3 Spinal cord tethering can be a result of SCH or as a standalone issue.4,5 These conditions can lead to progressive neurological deficits, including numbness, gait disturbances, and decreased muscle strength, requiring surgical correction. There are limited reports of surgical procedures for ventral SCHs. Several reports exist using a ventral approach for intradural tumors, but it is not commonly employed because of the inability to obtain adequate dural closure.6 Much of the literature on SCH comes from idiopathic and congenital cases in the thoracic spine.7,8 Posterior and posterolateral approaches for a ventral thoracic SCH have been described, as well as an anterior approach for a ventral cervical SCH.9-12 In this video, we describe a posterior approach for a ventral cervical SCH. A 38-yr-old male presented with progressive cervical myelopathy 9 yr after a C2-C3 schwannoma resection requiring an anterior approach and corpectomy of C3 with partial corpectomies of C2 and C4. A preoperative magnetic resonance imaging showed a ventrally herniated spinal cord at the top of the C3 vertebral body and below the C4 vertebral body. Informed consent was obtained. The posterior surgical approach involved a C1-C5 laminectomy, sectioning the dentate ligament, ventral cord untethering, removal of residual tumor, and placement of a ventral sling. A significant improvement in sensory and motor function was observed postoperatively.

Cervical Spondylotic Myelopathy with Ossification of Posterior Longitudinal Ligament: Which Is the Most Suitable Surgical Procedure? A Technical Note.

Introduction Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely performed to resolve anterior cervical spine compression. The main purpose of the different surgical techniques is to obtain an adequate decompression of the spinal cord and nerve roots, preserving spinal stability like in oblique corpectomy or leading to a final solid construct to achieve arthrodesis. Technical Note We describe a surgical procedure for treating cervical spondylotic myelopathy(CSM) with ossification of the posterior longitudinal ligament (OPLL) at the level of C3-C4 and C4-C5. A double level discectomy C3-C4 and C4-C5 and selective posterior wedge corpectomy of C3, C4, and C5 were performed. Two cages (Zero-P VA) at C3-C4 and C4-C5 were positioned to obtain segmental stability and arthrodesis. An extended anterior cervical canal decompression was obtained and confirmed by postsurgical CT scan. At 15 months, dynamic X-ray showed fusion, and cervical magnetic resonance imaging (MRI) showed evidence of spinal canal decompression. Conclusions Anterior cervical discectomy followed by selective wedge corpectomy appears to be a safe and effective technique for anterior spinal cord compression extending above and below the intervertebral disc space.

A Recurrent Cervical Neurenteric Cyst Treated Anteriorly: Safe, Gross-Total Excision Facilitated by Prophylactic Unilateral Vertebral Artery Exposure, Microdissection, and Spinal Cord Monitoring—A Case Report and Technical Note

This study reports on a 67-year-old woman with partial Brown-Séquard syndrome due to a recurrent cervical neurenteric cyst at C3 to C4. The myelopathic symptoms reappeared 22 years after a previous shunting operation performed posteriorly with a silicone tube connecting the intradural cervical cyst cavity to the subarachnoid space. We have now succeeded in removing the cyst nearly completely with the anterior approach. The surgical procedure consisted of right vertebral artery exposure at C3 and C4 and a subtotal corpectomy of C3 followed by microdissection of the cyst, duraplasty, and iliac strut graft fusion. Spinal cord monitoring with motor-evoked potential studies helped us safely dissect the cyst wall tightly adhering to the spinal cord. Duraplasty with Gore-Tex patch-grafting in conjunction with postoperative lumbar subarachnoid drainage worked well in preventing a spinal fluid fistula. At two years after surgery, the patient showed a nearly complete return of function without any recurrence of the cyst.

Surgical Treatment of a C3-osteoblastoma with Cord Compression and Encompassing the Vertebral Artery via Combined Approach

Background Osteoblastoma is a rare and benign osteoid-producing primary bone tumor that affects mainly the long bones. 36% of these tumors are observed around the spine and the vast majority arises around the posterior. Case Presentation: This report describes a case of C3 osteoblastoma occurring in a 22-years old male. He represented with cervical pain and quadriparesia. Cervical CT and MRI demonstrated an osteolytic mass that invade anterior and posterior elemant of C3 and cause severe cord compression. Because of the close proximity of the osteoblastoma to the vertebral artery canal and cord total resection of tumor was a challenging decision. To prevention of vertebral artery injury, laminectomy and partial resection of tumor was done with posterior approach and bilateral vertebral arteries preserved and then fussed with lateral mass screw. For best reconstruction and stability, total C3 corpectomy and anterior fusion with allograft and plate was done via anterior cervical approach. Conclusions Osteoblastoma in cervical spine with involvement of anterior and posterior part of vertebrae is a rare pathology and can encase vertebral artery. This case has favorable prognosis after 2 sessions surgery and adequate rehabilitation.

Spinal Decompression with 360&amp;amp;deg; Instrumented Fusion for Unstable Tuberculous Quadriplegia in a Young Adult—A Case Report

Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadriplegia from tuberculous destruction of C3 to C5 vertebral bodies and their intervening discs, aretropharyngeal prevertebral abscess and associated segmental kyphosis. He had received prior antituberculous therapy with no improvement. Results: He recovered completely neurologically when he had adequate decompression and 360°; instrumented fusiondone in a 3-stage surgery that involved drainage and debridement of the retropharyngeal prevertebral abscess, anterior corpectomy of C3 and C4 with fusion using a titanium mesh cage, and posterior fusion of C3 to C6 using titanium rods and lateral mass screws. Surgical treatment was supported with skull traction and antituberculous therapy. Conclusion: This case shows that complete neurologic recovery is feasible in spinal quadriplegia that fails to respond to antituber-culous therapy when adequate decompression and fusion are done.

Minimally Invasive Revision of a C2 Isthmus Screw

We present a novel technique for minimally invasive revision of a cervical isthmic screw via two 18-mm transmuscular tubular accesses. A 55 year old male with combined anterior and posterior instrumentation after corpectomy of C3 to C4 complained of persistent neck pain and reduced head mobility in the follow-up examination. Isthmic screws had been placed in C2 and pedicle screws in C5. The system used is a versatile modular screw-rod system for the fixation of the occipito-cervico-thoracic spine. The patient's complaints were attributed to an inappropriately placed C2 isthmus screw. The screw was approximately 3 mm too long and perforated the C1-C2 facet joint on the left side. We replaced the screw by a shorter one through a minimally invasive transmuscular tubular approach. The transmuscular tubular access offered an adequate exposure of the screw head. The special features of the versatile modular fixation device allowed for screw easing, removal, replacement, and tightening through the tube. The symptoms of the patient resolved completely. Intraoperative blood loss and postoperative approach-associated pain were negligible. We conclude that in case of dorsal cervical fixation with a versatile modular screw-rod system, a minimally invasive transmuscular approach for revision of an isthmic screw may be a good alternative to open surgery.

Anterior C3 corpectomy and fusion for complex Hangman’s fractures

The aim of this study was to assess the effectiveness and feasibility of anterior C3 corpectomy and fusion with screw-plate fixation of C2-4 for the treatment of Hangman's fracture in which spinal cord compression comes from the posterosuperior part of C3 vertebral body and the intervertebral disc injury at the C2-3 level. From August 2000 to December 2005, 11 patients (eight males and three females) with traumatic spondylolisthesis of the axis underwent the above surgery. Neurological status was evaluated by the Japanese Orthopaedic Association Score (JOA score). The fusion of the graft, healing of the fracture, and range of motion of the whole cervical spine were examined according to X-ray imaging. No patient received blood transfusion. There was no deterioration of the neurological function in any case postoperatively. The mean JOA score was significantly improved from 9.1 ± 2.3 preoperatively to 14.8 ± 1.2 at the 12-month postoperative visit. All patients were relieved of axial pain. Imaging evaluation confirmed a high fusion rate and healing rate in all patients. No patient complained of limited mobility of the cervical spine in flexion, extension and rotation. No graft or plate-related complication was observed in any patients during the whole follow-up period. The only postoperative complication was trouble in swallowing liquids in two cases which resolved three months after surgery without any treatment. Anterior C3 corpectomy and fusion may prove to be safe and applicable for the treatment of complex Hangman's fractures.

Hemangiopericytomas of the spine: case report and review of the literature

We describe a rare case of a primary intracranial meningeal hemangiopericytoma (HPC) with late metastasis to the cervical spine. A 36-year-old woman had a left occipital lesion that was histopathologically identified as HPC. Fourteen years after resection, the tumor recurred and was treated with radiotherapy. Three years later, CT imaging showed a large mass in the liver consistent with metastatic HPC, and MRI of the cervical spine showed an extensive lesion of the C3 vertebral body. The patient underwent C3 corpectomy with en-bloc tumor removal and follow-up radiation with no local recurrence or other spinal metastasis for the following 4 years. Regardless of the subtype of spinal HPC, complete surgical removal and radiotherapy appear to be treatment of choice.

Fibrous dysplasia of the cervical spine presenting as a pathological fracture

Fibrous dysplasia (FD) is an uncommon benign fibro-osseous abnormality of bone, of unknown aetiology and equal sex incidence, which is most commonly restricted to one bone (monostotic FD: MFD, 70%). Less commonly multiple bones are affected (polyostotic FD: PFD, 27%). Vertebral involvement is uncommon (4%), but more common with PFD (7 - 24%) than MFD (1%). Of 20 cases of FD involving the cervical spine, only three have represented MFD. Unlike cases associated with PFD, all cases presented with acute neck pain without significant neurological impairment after minor trauma. We present the case of a 35-year-old male with MFD who developed a pathological fracture of C3 following minor trauma. Radiographs showed collapse and typical 'ground glass' lucency of C3. CT revealed replacement of C3 cancellous bone by hypodense tissue extending into the right lateral mass. The cortex was thinned and fractured, and encroached upon the right foramen transversarium and spinal canal. Magnetic resonance imaging demonstrated hypo-intensity on both T1 and T2, with uniform contrast enhancement. Subtotal excision was achieved via an anterior C3 corpectomy, with residual FD left within the right lateral mass. Stability was achieved utilizing an iliac crest strut autograft, C2 - 4 plate-and-screws, and mobilization in a halo frame for 3 months. At 18 months, he remained asymptomatic and without deficit. Radiography, CT and MRI confirmed graft fusion without FD invasion, but with residual right lateral mass FD unchanged in size.