Vieweg U, Meyer B, Schramm J
Department of Neurosurgery, Friedrich-Schiller University Jena, Germany.
Acta Neurochir (Wien). 2001;143(3):217-25. doi: 10.1007/s007010170101.
A series of tumour cases of the upper cervical spine who we had treated was analysed retrospectively with respect to surgical complications, quality of life and survival, 13 patients (mean age 56 years, metastases 6, plasmocytomas 3, chordomas 2, histiocytosis 1, aneurysmal bone cyst 1) with tumours of the upper cervical spine (C2 n = 7, C2 and C3 n = 4, C3 n = 2) were treated during an 8-year period. A total of 16 operations were carried out with ten one-step procedures and three two step-procedures. Eight extra-oral, one transoral, three dorsal and, in one case, a combined dorsal and extra-oral tumour removal were performed. Four dorsal stabilisation's, four ventral platings and two combined ventral platings plus dorsal fixations and eight vertebral body replacements were carried out. The neurological status and the quality of life were analysed preoperatively and during the follow-up examinations. Flexionextension radiographs were taken during follow-up. There was no operative mortality. The transient morbidity was 8%. The operative intervention significantly improved the quality of life in all patients during the follow-up visits (mean: 20 months). No instability was seen. The average survival time of all patients was 23 months. Six patients died following the operation after a mean time of 28 (4-64) months. Tumour removal in the upper cervical spine using individually modified surgical strategies based on an approach combining tumour location, stabilisation and vertebral body replacement significantly increases the time of survival and quality of life with an acceptable surgical risk for complications.
对我们治疗过的一系列上颈椎肿瘤病例进行回顾性分析，内容涉及手术并发症、生活质量和生存率。在8年期间，对13例（平均年龄56岁，其中转移瘤6例、浆细胞瘤3例、脊索瘤2例、组织细胞增多症1例、动脉瘤样骨囊肿1例）上颈椎肿瘤患者（C2节段7例、C2和C3节段4例、C3节段2例）进行了治疗。共实施了16次手术，其中10次为一步手术，3次为两步手术。进行了8次口外手术、1次经口手术、3次后路手术，还有1例采用了后路与口外联合肿瘤切除术。实施了4次后路固定、4次前路钢板固定、2次前路钢板联合后路固定以及8次椎体置换。术前及随访期间对神经状态和生活质量进行了分析。随访期间拍摄了屈伸位X线片。无手术死亡病例。短暂性并发症发生率为8%。在随访期间（平均20个月），手术干预显著改善了所有患者的生活质量。未见不稳定情况。所有患者的平均生存时间为23个月。6例患者术后死亡，平均时间为28（4 - 64）个月。基于肿瘤位置、固定和椎体置换相结合的方法，采用个体化改良手术策略对上颈椎肿瘤进行切除，可显著提高生存时间和生活质量，且手术并发症风险可接受。
