Neurosurgery Service, Centre Hospitalier Universitaire de Grenoble Alpes, La Tronche, France.
Spine Unit, Department of Orthopedic Surgery, University Hospital of Umea, Umea, Sweden.
World Neurosurg. 2019 Dec;132:303-308. doi: 10.1016/j.wneu.2019.07.208. Epub 2019 Aug 5.
Primary Ewing sarcoma of the mobile spine is a rare disease. Its management requires careful surgical planning, because radical, margin-free excision is directly correlated with prognosis. Extensive bone removal in the cervical spine can lead to instability and cause postoperative iatrogenic cervical deformity. Thus, spinal instrumentation plays an important role in restoring postresection spinal stability and improving quality of life.
We present a novel technique that allows successful removal of a large Ewing sarcoma of the subaxial cervical spine, infiltrating and traversing the posterior bone elements, and extending into the paraspinal muscles. This technique involves radical en bloc resection of posteriorly located cervical tumors via multilevel pediculotomy, with terminal vertebrae pedicle screw reconstruction.
Terminal vertebrae cervical pedicle screw reconstruction allowed wide surgical excision with satisfactory oncologic and mechanical results.
This technique enables 1-stage total tumor resection and stabilization and may be a viable alternative to radical en bloc resection of posteriorly located epidural malignant lesions of the cervical spine in selected cases.
原发性骨尤文肉瘤（Ewing sarcoma）发生于活动脊柱较为罕见。其治疗需要仔细的手术规划，因为广泛、无边界的切除与预后直接相关。颈椎广泛的骨质切除可能导致不稳定，并导致术后医源性颈椎畸形。因此，脊柱内固定在重建术后脊柱稳定性和提高生活质量方面发挥着重要作用。
我们提出了一种新的技术，成功切除了一个大的下颈椎尤文肉瘤，该肿瘤穿透了后方的骨结构，并延伸至椎旁肌肉。该技术通过多节段椎弓根切开术对位于后方的颈椎肿瘤进行根治性整块切除术，并用末端椎弓根螺钉重建。
末端椎弓根螺钉重建允许广泛的手术切除，并获得满意的肿瘤学和力学结果。
该技术能够实现 1 期全肿瘤切除和稳定，对于某些特定病例，可能是一种可行的替代方案，用于根治性整块切除颈椎后方硬膜外恶性病变。
