Marengo Nicola, Di Perna Giuseppe, Baldassarre Bianca Maria, Cofano Fabio, De Marco Raffaele, Zeppa Pietro, Petrone Salvatore, Ajello Marco, Garbossa Diego, Zenga Francesco
Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, University of Turin, Turin, Italy.
Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy.
Front Surg. 2022 Nov 23;9:1011846. doi: 10.3389/fsurg.2022.1011846. eCollection 2022.
For spine surgeons, dealing with unstable cervical spine has been usually challenging, and this becomes more difficult when facing a primary craniovertebral junction tumor. Primary spine tumor surgery should always include column reconstruction in order to guarantee biomechanical stability of the spine, but surgeons should always be aware that instrumentations could create interferences with postoperative radiations. However, although carbon fiber instrumentations have started to be used in thoracolumbar oncology for few years, these options are still not available for cervical spine. In the reported case, the adopted strategy to obtain adequate column reconstruction was based on the idea of reducing the amount of titanium needed for posterior fixation and maximizing the distance between the radiation target and titanium rods.
We present the case of a 53-year-old woman harboring a craniovertebral junction chordoma. A short occipito-C3 construct was selected. Specifically, titanium cervical pedicle screws were placed by using a new technology consisting in patient-tailored and customized 3D-printed guides. The aim of this case report is to determine the feasibility and safety of 3D-printed guides for cervical pedicle screw (CPS) positioning, even in the case of cervical spine tumor.
CPS could represent a good solution by providing strong biomechanical purchase and tailored 3D-printed guides could increase the safety and the accuracy of this challenging screw placement, even in oncological patients.
对于脊柱外科医生而言，处理不稳定的颈椎通常具有挑战性，而当面对原发性颅颈交界区肿瘤时，这一挑战会变得更加艰巨。原发性脊柱肿瘤手术始终应包括椎体重建，以确保脊柱的生物力学稳定性，但外科医生应始终意识到内固定可能会对术后放疗产生干扰。然而，尽管碳纤维内固定已在胸腰椎肿瘤治疗中应用了数年，但这些选择在颈椎手术中仍不可用。在本报告的病例中，所采用的实现充分椎体重建的策略基于减少后路固定所需钛金属量以及最大化放疗靶区与钛棒之间距离的理念。
我们报告一例53岁患有颅颈交界区脊索瘤的女性病例。选择了一个短的枕骨至C3固定结构。具体而言，通过使用一种新技术放置钛制颈椎椎弓根螺钉，该技术包括患者定制的3D打印导向器。本病例报告的目的是确定3D打印导向器用于颈椎椎弓根螺钉（CPS）定位的可行性和安全性，即使是在颈椎肿瘤的情况下。
颈椎椎弓根螺钉通过提供强大的生物力学固定作用可能是一种很好的解决方案，而定制的3D打印导向器可以提高这种具有挑战性的螺钉置入的安全性和准确性，即使在肿瘤患者中也是如此。
