He Li-Ming, Ma Xun, Chen Chen, Zhang Hong-Yi
Department of Orthopedics, Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030032, Shanxi Province, China.
World J Clin Cases. 2021 Jan 26;9(3):644-650. doi: 10.12998/wjcc.v9.i3.644.
Cervical spondylectomy for the treatment of cervical tumors is traumatic, causes bleeding, and is risky. This study reports on the experience with minimally invasive cervical spondylectomy for a cervical metastasis and reviewed the literature on cervical spondylectomy. The purpose was to reduce the risk and trauma of spondylectomy.
A 60-year-old woman presented with cervical pain and radiating pain in the left upper limb for more than 2 mo. Preoperative diagnosis was C4 metastasis of thyroid cancer. Preoperative visual analogue scale score was 5. American Spinal Cord Injury Association (ASIA) grade was E. Tomita classification was 7. Weinstein-Boriani-Biagini (WBB) classification was A-D, 3-9. Tomita score was 5. Modified Tokuhashi score was 9. Spinal instability neoplastic score (SINS) was 13. The patient underwent minimally invasive cervical spondylectomy on September 28, 2017. The operative time was 200 min; the estimated blood loss was 1200 mL. The operation was successful, without complications. The postoperative visual analogue scale score was 0. The patient remained classified as ASIA grade E at the last follow-up. She accepted regular iodine-131 therapy postoperatively. The serum thyroglobulin (Tg) level of this patient was 299.02 ng/mL at 1 mo after the operation and was 13.57 ng/mL at the last follow-up. There was no local recurrence at the 25-mo follow-up, according to images, single-photon emission computed tomography, and serum Tg levels. Obvious ossification and solid fusion of C3-C5 were found at the last follow-up.
Minimally invasive cervical spondylectomy with tubular retractor could minimize soft tissue trauma, intraoperative traction injury, and paraspinal muscle injury, accelerating postoperative recovery. This technique requires a rich experience in cervical spine surgery with tubular retractors, so that surgeons can visualize the anatomical structure in a small field.
颈椎肿瘤切除术治疗颈椎肿瘤具有创伤性，会导致出血，且存在风险。本研究报告了微创颈椎肿瘤切除术治疗颈椎转移瘤的经验，并回顾了颈椎肿瘤切除术的相关文献。目的是降低肿瘤切除术的风险和创伤。
一名60岁女性出现颈部疼痛及左上肢放射痛2个多月。术前诊断为甲状腺癌C4转移。术前视觉模拟评分5分。美国脊髓损伤协会（ASIA）分级为E级。Tomita分级为7级。Weinstein-Boriani-Biagini（WBB）分级为A-D，3-9。Tomita评分5分。改良Tokuhashi评分9分。脊柱不稳定肿瘤评分（SINS）为13分。该患者于2017年9月28日接受了微创颈椎肿瘤切除术。手术时间为200分钟；估计失血量为1200毫升。手术成功，无并发症。术后视觉模拟评分0分。末次随访时患者仍为ASIA E级。术后接受了常规碘-131治疗。该患者术后1个月血清甲状腺球蛋白（Tg）水平为299.02 ng/mL，末次随访时为13.57 ng/mL。根据影像学、单光子发射计算机断层扫描及血清Tg水平，25个月随访时无局部复发。末次随访时发现C3-C5明显骨化及牢固融合。
采用管状牵开器的微创颈椎肿瘤切除术可使软组织创伤、术中牵拉损伤及椎旁肌损伤最小化，加速术后恢复。该技术需要在使用管状牵开器进行颈椎手术方面有丰富经验，以便外科医生能在小视野内看清解剖结构。
