Customized “Whole-Cervical-Vertebral-Body” Reconstruction After Modified Subtotal Spondylectomy of C2-C7 Spinal Tumor Via Piezoelectric Surgery

2019 ◽  
Vol 17 (6) ◽  
pp. 580-587 ◽  
Author(s):  
Shaohui He ◽  
Xinghai Yang ◽  
Jian Yang ◽  
Chen Ye ◽  
Weibo Liu ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Radical Resection ◽  
Spinal Tumor ◽  
Uneventful Recovery ◽  
Spinal Tumors ◽  
Neurological Improvement ◽  
Piezoelectric Surgery ◽  
3D Printed

Abstract BACKGROUND Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine. OBJECTIVE To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery. METHODS A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability. RESULTS The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence. CONCLUSION The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.

A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report

2021 ◽  
pp. 1-7
Author(s):  
Marko Jug
Keyword(s):  
Cervical Spine ◽  
3D Model ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Upper Cervical Spine ◽  
Spine Instrumentation ◽  
Cord Injury ◽  
Spinal Navigation ◽  
Upper Cervical ◽  
3D Printed

<b><i>Introduction:</i></b> In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. <b><i>Case Presentation:</i></b> We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. <b><i>Discussion/Conclusion:</i></b> Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.

Improving Cutting Path on Custom 3D-Printed Surgical Guides for Bone-Tumor Resection

2019 ◽  
Author(s):  
Carlos G. Helguero ◽  
Juan Castro ◽  
César Ochoa ◽  
Fausto Maldonado ◽  
Emilio A. Ramírez ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Element Analysis ◽  
Surgical Guides ◽  
Orthopedic Oncology ◽  
3D Printed ◽  
Bone Tumor Resection ◽  
High Level ◽  
Cutting Path

Abstract Custom three-dimensional (3D) printed guides are being used in the operative room as an aid to surgeons for increasing the accuracy of their cutting and resection techniques. In terms of bone-tumor resection, the cutting path printed in the custom jig is significantly important for two main purposes: first, the required fit for the implant that will replace the resected bone section and, second, the interaction between the remaining, healthy bone and the new implant in terms of forces, stresses and deformation. Bone tumor resection has posed a challenge in orthopedic oncology, specifically due to a high level of difficulty in performing a limb-sparing surgery with negative margins on the remaining bone. A straight cutting path is usually used in clinical procedures due to the type of tooling available inside the operative room. 3D printed cutting path guides offer the possibility to evolve from a straight to a different path, e.g. a tapered path, and overcome fitting problems during surgery. This work investigates the current straight cutting path used for typical bone tumor resection and compares it to a proposed tapered cutting path in terms of both implant fitting and stress analysis. Finite element analysis software is used to simulate a compression force exerted over the femur bone. Different taper cut angles are studied and results are reported to obtain an ideal angle for resection. Results are presented to evidence the need to evolve from the current resection technique in order to minimize the number of revision surgeries and for a better quality of life of patients under this type of surgical procedure.

scholarly journals Management of cervical spine deformity after intradural tumor resection

2015 ◽  
Vol 39 (2) ◽  
pp. E13 ◽  
Author(s):  
Andrei F. Joaquim ◽  
K. Daniel Riew
Keyword(s):  
Cervical Spine ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Spine Deformity ◽  
Surgical Strategies ◽  
Coronal Imbalance ◽  
Intradural Tumor ◽  
Cervical Spine Alignment ◽  
Functional Deterioration

Management of intradural spinal tumors requires posterior decompressive techniques. Cervical spine deformity secondary to sagittal and/or coronal imbalance after a laminectomy may result in significant cervical pain and functional deterioration, as well as neurological deficits in the most severe cases. In this paper, the authors discuss the management of cervical spine deformity after intradural tumor resection, with emphasis on the surgical strategies required to reestablish acceptable cervical spine alignment and to correct postoperative deformity. In general, after an oncological evaluation, assessing the alignment, extent, and flexibility of the deformity is mandatory before surgical planning. Rigid deformities require an osteotomy and, most often, combined approaches to restore cervical alignment. Flexible deformities can often be treated with a single approach, although a circumferential approach has its advantages.

Neck Tumor Dissection Improved With 3-Dimensional Ultrasound Image Guidance: Technical Case Report

2014 ◽  
Vol 10 (1) ◽  
pp. E183-E189
Author(s):  
Laura A. Snyder ◽  
Cameron G. McDougall ◽  
Robert F. Spetzler ◽  
Joseph M. Zabramski
Keyword(s):  
Case Report ◽  
Real Time ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Ultrasound Image ◽  
Spinal Tumors ◽  
3 Dimensional ◽  
Neck Tumors ◽  
Ultrasonic Navigation ◽  
Large Neck

Abstract BACKGROUND AND IMPORTANCE: Three-dimensional ultrasound navigation has been performed to assist in resection of cranial and spinal tumors, but to the best of our knowledge, no one has described the use of real-time 3-dimensional ultrasound navigation in the resection of neck tumors beyond biopsy. CLINICAL PRESENTATION: This case report describes the use of 3-dimensional ultrasonic navigation in assisting with resection of a large neck paraganglioma. The 3-dimensional ultrasonic navigation improved real-time visualization of the carotid arteries, the trachea, and other vital structures. CONCLUSION: The use of 3-dimensional ultrasound navigation should be considered in aiding resection of large neck tumors because it can allow more efficient and safer tumor resection.

scholarly journals Improved patient quality of life following intradural extramedullary spinal tumor resection

2016 ◽  
Vol 25 (5) ◽  
pp. 640-645 ◽  
Author(s):  
Matthew J. Viereck ◽  
George M. Ghobrial ◽  
Sara Beygi ◽  
James S. Harrop
Keyword(s):  
Quality Of Life ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Spinal Tumor ◽  
Administrative Database ◽  
Spinal Tumors ◽  
Descriptive System ◽  
Intradural Extramedullary

OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. METHODS A retrospective review of a single institutional neurosurgical administrative database was conducted to analyze clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and the EQ-5D-3 L descriptive system were used to analyze quality of life preoperatively, less than 1 month postoperatively, 1–3 months postoperatively, 3–12 months postoperatively, and more than 12 months postoperatively. RESULTS The ODI scores increased perioperatively at the < 1-month follow-up from 36 preoperatively to 47. Relative to preoperative values, the ODI score decreased significantly at 1–3, 3–12, and > 12 months to 23, 17, and 20, respectively. VAS scores significantly decreased from 6.1 to 3.5, 2.4, 2.0, and 2.9 at the < 1-month, 1- to 3-, 3- to 12-, and > 12-month follow-ups, respectively. EQ-5D mobility significantly worsened at the < 1-month follow-up but improved at the 3- to 12-and > 12-month follow-ups. EQ-5D self-care significantly worsened at the < 1-month follow-up but significantly improved by the 3- to 12-month follow-up. EQ-5D usual activities improved at the 1- to 3-, 3- to 12-, and > 12-month follow-ups. EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.

scholarly journals Post-Operative Neurological Outcome of Intradural Spinal Tumors in Terms of Improvement In Mccormick’s Classification Scheme

2021 ◽  
Vol 8 (4) ◽  
pp. 9-13
Author(s):  
Naseer Hassan ◽  
Mehran Ali ◽  
Mansoor Ahmad ◽  
, Hanif Ur Rehman ◽  
Hamayun Tahir ◽  
...  
Keyword(s):  
Neurological Examination ◽  
Neurological Outcome ◽  
Classification Scheme ◽  
Spinal Tumor ◽  
Operational Definition ◽  
Affected Individual ◽  
Spinal Tumors ◽  
Neurological Improvement ◽  
The Mean ◽  
Positive Effect

OBJECTIVES: To determine the post-operative neurological outcome of intradural spinal tumors in terms of improvement in McCormick classification scheme.METHODOLOGY:  Total of 95 patients diagnosed as case of intradural spinal tumor as per operational definition with any McCormick grade were analyzed. After admission and complete neurological examination, pre-operative McCormik’s grades of each patient were determined and followed for one month after surgery. During their stay they were assessed for neurological improvement as per McCormick grade.RESULTS:There were total 95 patients presenting in OPD with the mean age of 45±12.36 years. There were 42% male and 58% female. There were 62% patients who were improved in neurological outcome while 38% patients were not improved. CONCLUSION:Surgical removal of spinal tumor is beneficial to the affected individual and has positive effect on his life.

scholarly journals Spinal Schwannoma as Pregnancy Related Spinal Tumor

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Kadek Dede Frisky Wiyanjana ◽  
Kevin Kristian Putra ◽  
Sri Maliawan ◽  
I Made Gotra
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Tumor Resection ◽  
Spinal Tumor ◽  
Sensory Loss ◽  
Spinal Tumors ◽  
Low Back ◽  
Peripheral Nerve Sheath Tumors ◽  
Spinal Schwannoma

Spinal schwannoma is the most common benign spinal tumors that originated from peripheral nerve sheath tumors. Male and females are equally affected. Due to hormonal imbalance during pregnancy, it might affect the release of the tumor-growth factor. The symptoms usually start with pain and sensory loss at the spinal cord level. We report a case of thoracolumbar schwannoma with a history of chronic low back pain since post-pregnancy. A Thirty-Seven years old female, suffered chronic low back pain for 3 years since she had a pregnancy. In the last 4 months, she suffered paresis and tingling sensation on the right foot. MRI shown intradural mass at Th 12 – L2. Biopsy, tumor resection, and laminectomy were performed to do the histopathology analysis, resect, and stabilization. Histopathology examination revealed Schwannoma types. The patient was discharged three days after complete tumor resection and stabilization, with an improvement of neurological function. Spinal Schwannoma can occur as a Pregnancy-related spinal tumor (PRST), it can be diagnosed during pregnancy or within a year after delivery. The incidence is rare, therefore proper workup and early examination are needed and followed by careful and considerate treatment.

scholarly journals Chordomas, malignant spinal tumors: a 15-year experience

2016 ◽  
Vol 30 (1) ◽  
pp. 15-27
Author(s):  
Niki Adrian Calina ◽  
Cristian Filip ◽  
Daniel Serban ◽  
Marius Podea ◽  
Costica Zamfir ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Tumor Resection ◽  
Disease Process ◽  
Malignant Neoplasm ◽  
Radical Resection ◽  
Bowel Dysfunction ◽  
Spinal Tumors ◽  
Spinal Instability ◽  
Total Resection ◽  
Bladder Bowel Dysfunction

Abstract Objective: Spinal chordomas are rare, locally invasive, malignant neoplasm, representing 5% of all malignant tumors of the skeleton. In the majority of cases the segment involved is the sacrum. This study reviews our experience during the last 15 years at The Spinal Surgery Department of “Bagdasar-Arseni” Clinical Hospital, to determine the effects of various treatment methods on the overall course of this disease process. Methods: A retrospective study was performed, from 2000 to 2015, in which, 31 patients with spinal chordomas were evaluated at our institution. Results: Two thirds of patients were male, with a mean age of 57 years. Patients presented with local pain, radiculopathy and bladder-bowel dysfunction at hospital admission. There were 24 patients with sacral chordomas, 4 with cervical chordomas, 2 with thoracic and one with lumbar chordoma. All patients underwent at least one surgical procedure. The main goal of surgery was to achieve total resection of the tumor. Conclusion: Our study suggests that spinal chordomas are rare tumors with a high risk of tumor recurrence. If total resection is achieved, the risk of recurrence diminishes. If the tumor resection is subtotal, than recurrence appears in all cases. After tumor resection, the surgeon faces the problem of spinal instability that needs solving. Based on these findings, we think that, whenever possible, radical resection should be the treatment of choice for spinal chordomas.

Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases

2019 ◽  
Vol 30 (4) ◽  
pp. 424-431 ◽  
Author(s):  
A. Karim Ahmed ◽  
Zachary Pennington ◽  
Camilo A. Molina ◽  
Yuanxuan Xia ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Planning ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Careful Consideration ◽  
Spinal Tumors ◽  
Surgical Morbidity ◽  
En Bloc ◽  
Spine Tumors ◽  
3D Printed

Effective en bloc resection of primary spinal tumors necessitates careful consideration of adjacent anatomical structures in order to achieve negative margins and reduce surgical morbidity. This can be particularly challenging in the cervical spine, where vital neurovascular and connective tissues are present in the region. Early multidisciplinary surgical planning that includes clinicians and engineers can both optimize surgical planning and enable a more feasible resection with oncological margins. The aim of the current work was to demonstrate two cases that involved multidisciplinary surgical planning for en bloc resection of primary cervical spine tumors, successfully utilizing 3D-printed patient models and neoadjuvant therapies.

Surgical management of chordomas of the cervical spine

2007 ◽  
Vol 6 (5) ◽  
pp. 398-406 ◽  
Author(s):  
Ignacio J. Barrenechea ◽  
Noel I. Perin ◽  
Aymara Triana ◽  
Jonathan Lesser ◽  
Peter Costantino ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Tumor Resection ◽  
Radical Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Anterior Fusion ◽  
En Bloc ◽  
Stabilization Procedure ◽  
Second Resection ◽  
Cervical Chordoma

Object Chordomas of the cervical spine are rare tumors. Although en bloc resection has proven to be the ideal procedure in other areas, there is controversy regarding this approach in the cervical spine. The goal in this study was to determine whether piecemeal tumor resection was efficient in the management of chordomas that arise in this location. Methods The authors retrospectively reviewed all 74 cases of chordoma treated by their group. Seven patients with isolated cervical chordomas who were treated between October 1992 and January 2006 were identified. There were four male and three female patients, whose ages ranged from 6 to 61 years (mean 34.4 years). Follow-up duration ranged from 7 to 169 months (median 23 months). All cases were managed using a retrocarotid approach with mobilization of the vertebral artery. When the tumor could not be completely resected via the initial anterior approach, a subsequent posterior resection was performed. Tumor resection was intralesional in all cases, and gross-total tumor resection was achieved in six cases. One patient required a second resection 4 months later. In all cases, a posterior stabilization procedure was performed. Five patients underwent anterior fusion (three with fibular allograft and two with iliac crest), whereas two underwent occipitocervical fusion. In two patients with dedifferentiated chordoma metastasis developed, and one of them died 7 months later. The other patient with metastasis died suddenly at home 26 months postsurgery, presumably from aspiration. At the time of this submission, there were no signs of recurrence in five patients. Conclusions The authors believe that, in most cases, en bloc resection of cervical chordoma is not feasible. This is due to the tendency of chordomas to involve multiple compartments at the time of diagnosis. In the authors' experience, intralesional radical resection remains an effective surgical approach to this disease entity.

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