Adult ; Cervical Vertebrae ; pathology ; surgery ; Humans ; Male ; Spinal Neoplasms ; pathology ; surgery ; Teratoma ; pathology ; surgery

Cervical Vertebrae ; pathology ; surgery ; Humans ; Laminoplasty ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Diseases ; pathology ; surgery

The authors report on a case of primary malignant melanoma of the 7th cervical spinal nerve root in a 45-year-old woman. Neuro-radiological features of this extra-dural mass were suggestive of a nerve sheath tumor. The lesion underwent total gross resection through the anterolateral approach. The patient's postoperative course was uneventful. Histopathological investigation confirmed malignant melanoma. There was no evidence of tumor recurrence or other melanotic lesions on regular follow-up examinations until the postoperative eighth month. When treating a common, benign-looking lesion of the cervical spinal nerve root, surgeons should be aware of the potential to encounter such a malignant tumor.
Cervical Vertebrae ; Female ; Human ; Melanoma/*pathology/surgery ; Middle Aged ; Nerve Sheath Tumors/*pathology/surgery ; Peripheral Nervous System Neoplasms/*pathology/surgery ; Spinal Nerve Roots/*pathology

OBJECTIVETo investigate an approach of posterior cervical spinal canal decompression and re-establishing the insertion of extensor, aim at the ossification of the posterior longitudinal ligament (OPLL) involved in C(2).

METHODSFrom 2002 to 2006, 10 patients with OPLL involved in C(2) underwent open-door laminoplasty, with the posterior cervical ligamentous complex and the insertion of extensor reconstructed on C(2), were reviewed retrospectively. The range of decompression was from C(2) to C(7). The sagittal diameter of C(2) vertebral canal, alignment of the cervical spine (C(2)-C(7) angle), and JOA score before and after operation were contrasted respectively.

RESULTSAll patients were followed up, average 14 months. Before the operation, the average sagittal diameter of C(2) vertebral canal was 5.6 mm (4 - 8.8 mm), JOA score was 9.6 scores (6 - 12 scores), C(2)-C(7) angle was 6.5 degrees (-2 degrees - 12 degrees ). After the operation, the average sagittal diameter of C(2) vertebral canal was 13.4 mm (10 - 18.2 mm, P < 0.01), JOA score was 10.9 scores (8 - 14 scores) and the C(2)-C(7) angle was 7.4 degrees (3 degrees - 14 degrees ) in earlier. Finally, the JOA score was 13.2 scores (10 - 17 scores, P < 0.05), and the C(2)-C(7) angle was 7.0 degrees (2 degrees - 15 degrees , P > 0.05) at last.

CONCLUSIONSThe open-door laminoplasty, with an approach of the posterior cervical ligamentous complex and the insertion of extensor reconstructed, is an appropriate method for treating OPLL involved in C(2). This process keeps the cervical curve in a better way, and decompresses the spinal canal effectively.

Aged ; Axis, Cervical Vertebra ; pathology ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; pathology ; surgery

OBJECTIVETo evaluate the efficacy of allograft fibula in anterior cervical fusion for cervical spondylosis patients treated by Smith-Robinson operation supplemented with anterior instrumentation.

METHODSThe clinical outcome of 38 patients with cervical spondylosis treated by Smith-Robinson operation using allograft fibula supplemented with anterior titanium plate were retrospectively studied. The patients were followed up on average was (9.5 +/- 3.4) months. The average preoperative and postoperative JOA scores were assessed and myelopathy severity was graded using the Nurick myelopathy grading system. Lateral views in neutral position, in flexion, and in extension of preoperative cervical roentgenograms were analyzed in comparison with last follow-up films to identify the changes in the height of intervertebral space and the quality of fusion.

RESULTSStatistical analysis of all patients revealed mean JOA scores of 12.54 +/- 1.62 and 16.07 +/- 1.13 before surgery and at final examination (P < 0.05), respectively. And the mean Nurick grades were 2.46 +/- 0.43 and 0.72 +/- 0.37 before and after surgery (P < 0.05), respectively. Radiographic follow-up revealed that the height intervertebral space and the lordosis of the cervical spine had been restored and no allograft was found displaced or collapsed and also revealed that all grafts obtained union by 5 months after surgery.

CONCLUSIONSFibular allograft can replace autologous iliac crest graft in the treatment of cervical spondylosis patients. This method is safe and efficacious and can avoid bone graft-site morbidity.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Female ; Fibula ; surgery ; Humans ; Male ; Middle Aged ; Spinal Osteophytosis ; surgery ; Transplantation, Homologous

OBJECTIVETo explore the early clinical effect and safety of percutaneous transforaminal endoscopic technology for cervical spondylotic radiculopathy.

METHODSFrom August 2016 to September 2017, 14 patients with cervical spondylotic radiculopathy who responded poorly to non-surgical treatment for at least 6 weeks underwent percutaneous transforaminal endoscopic discectomy via posterior approach. There were 6 males and 8 females, aging from 32 to 68 years old with an average of (40.5±7.6) years. The course of disease ranged from 0.5 to 13.0 months with an average of (6.0±1.33) months. The lesions involved C₄,₅ in 2 cases, C₅,₆ in 8 cases, C₆,₇ in 4 cases. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Short Form 36 health survey questionnaire(SF-36) were recorded preoperatively and during the latest follow-up to evaluate the clinical outcome. Horizontal displacement and angular displacement of vertebral body were measured by cervical dynamic X-rays.

RESULTSAll operations were successful. No spinal cord injury, nerve root or vascular injuries were found. Operation time was from 60 to 100 min with a median of 75 min;intraoperative bleeding was from 30 to 80 ml with a median of 40 ml. All patients were followed up for 2 to 13 months with a median of 9 months. During the follow-up period, the patients with neck and shoulder pain were significantly relieved without recurrence. No nucleus pulposus protrusion was found in the primary surgical segment, and there was no obvious sign of degeneration in the adjacent vertebral body. At the latest follow-up, VAS, JOA and SF-36 scores were obviously improved(<0.05). There was no significant difference in horizontal displacement and angular displacement of vertebral body before and after the operation (>0.05). The cervical curvature at the latest follow-up was higher than preoperative findings (<0.05). And there was no significant difference in intervertebral disc height preoperatively and postoperatively(>0.05).

CONCLUSIONSPercutaneous transforaminal endoscopic discectomy in treating cervical spondylotic radiculopathy can effectively and safely relieve neck and shoulder pain, improving nerve function, enhance life quality, maintaining cervical stability. It is worthwhile to generalize and apply in clinical settings.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; surgery ; Spondylosis ; surgery ; Treatment Outcome

Cervical Vertebrae ; Hemangioma, Cavernous ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Rupture, Spontaneous ; Spinal Canal ; pathology ; Spinal Neoplasms ; diagnosis ; surgery

Acute neurologic deterioration is not a rare event in the surgical decompression for thoracic spinal stenosis. We report a case of transient paraparesis after decompressive laminectomy in a 50-yr-old male patient with multi-level thoracic ossification of the ligamentum flavum and cervical ossification of the posterior longitudinal ligament. Decompressive laminectomy from T9 to T11 was performed without gross neurological improvement. Two weeks after the first operation, laminoplasty from C4 to C6 and additional decompressive laminectomies of T3, T4, T6, and T8 were performed. Paraparesis developed 3 hr after the second operation, which recovered spontaneously 5 hr thereafter. CT and MRI were immediately performed, but there were no corresponding lesions. Vascular compromise of the borderlines of the arterial supply by microthrombi might be responsible for the paraparesis.
*Cervical Vertebrae/pathology/surgery ; Decompression, Surgical/adverse effects ; Humans ; Laminectomy/*adverse effects ; *Ligamentum Flavum/pathology/surgery ; *Longitudinal Ligaments/pathology/surgery ; Male ; Middle Aged ; *Ossification, Heterotopic ; Paraparesis/*etiology

A 40-year-old Asian female presented with a 2-month history of right shoulder pain and right triceps weakness. MRI revealed an extramedullary, extradural, dumbbell-shaped spinal cord tumor with C6 to C7 iso- and hyperintensity on T1 and T2 weighted imaging, respectively. Histological examination revealed monomorphous spindle cells with a storiform pattern. Immunohistochemistry was positive for CD34, CD99, and negative for EMA, SMA, and S100; solitary fibrous tumor (SFT) was confirmed.
Adult ; Cervical Vertebrae/*pathology/radiography/surgery ; Female ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Solitary Fibrous Tumors/*pathology/radiography/surgery ; Spinal Cord Neoplasms/*pathology/radiography/surgery ; Tomography, X-Ray Computed

BACKGROUNDChordomas of the upper cervical spine are rare and present unique surgical challenge. This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.

METHODSTwenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed. Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.

RESULTSThe postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case. The mean operative time was 9.5 hours (range 6-17 hours), and the mean blood loss was 2 812 ml (range 700-4 800 ml). There were two postoperative deaths. Unilateral vertebral artery ligation was performed in six patients, cervical nerve roots were cut in six patients, and the external branch of the superior laryngeal nerve was repaired after being cut in one case. Two patients developed postoperative velopharyngeal incompetence, and loosening of the occipitocervical screws was observed in one patient. The recurrence rate was 66.7% (10/15) after a mean follow-up period of 46.8 months (range 14-150 months). The 5- and 10- year overall survival rates were (39.8±13.1)% and (31.9±12.7)%, respectively. There was a significant difference in survival rate between patients who underwent surgery and those who did not.

CONCLUSIONIn spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine, intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival.

Adult ; Aged ; Cervical Vertebrae ; pathology ; surgery ; Chordoma ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; surgery ; Retrospective Studies ; Spinal Neoplasms ; pathology ; surgery ; Treatment Outcome