Hu Panpan, Du Suiyong, Wei Feng, Zhai Shuheng, Zhou Hua, Liu Xiaoguang, Liu Zhongjun
Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China.
Department of Spine Surgery, 521 Hospital of Norinco Group, Xi'an, China.
Front Oncol. 2022 Dec 19;12:1065303. doi: 10.3389/fonc.2022.1065303. eCollection 2022.
Surgical resection of C2 vertebral tumors is challenging owing to the complex anatomy of C2 vertebrae and the challenges to surgical exposure. Various surgical approaches are available, but some are associated with excessively high risks of complications. An additional challenge is reconstruction of the upper cervical spine following surgery. In the last decade, additive-manufacturing personalized artificial vertebral bodies (AVBs) have been introduced for the repair of large, irregular bony defects; however, their use and efficacy in upper cervical surgery have not been well addressed. Therefore, in this study, we compared instrumented fixation status between patients who underwent conventional titanium mesh reconstruction and those who underwent the same resection but with personalized AVBs.
We performed a retrospective comparative study and recruited a single-institution cohort of patients with C2 vertebral tumors. Clinical data and imaging findings were reviewed. Through data processing and comparative analysis, we described and discussed the feasibility and safety of surgical resection and the outcomes of hardware implants. The primary outcome of this study was instrumented fixation status.
The 31 recruited patients were divided into two groups. There were 13 patients in group A who underwent conventional titanium mesh reconstruction and 18 group B patients who underwent personalized AVBs. All patients underwent staged posterior and anterior surgical procedures. In the cohort, 9.7% achieved total en bloc resection of the tumor, while gross total resection was achieved in the remaining 90.3%. The perioperative complication and mortality rates were 45.2% and 6.5%, respectively. The occurrence of perioperative complications was related to the choice of anterior approach ( < 0.05). Group A had a higher complication rate than group B ( < 0.05). Four patients (4/13, 30.8%) developed hardware problems during the follow-up period; however, this rate was marginally higher than that of group B (1/18, 5.6%).
Total resection of C2 vertebral tumors was associated with a high risk of perioperative complications. The staged posterior and retropharyngeal approaches are better surgical strategies for C2 tumors. Personalized AVBs can provide a reliable reconstruction outcome, yet minor pitfalls remain that call for further modification.
由于C2椎体解剖结构复杂以及手术暴露困难，C2椎体肿瘤的手术切除具有挑战性。目前有多种手术入路可供选择，但有些入路的并发症风险过高。另一个挑战是术后上颈椎的重建。在过去十年中，增材制造的个性化人工椎体（AVB）已被用于修复大的、不规则的骨缺损；然而，它们在上颈椎手术中的应用和疗效尚未得到充分研究。因此，在本研究中，我们比较了接受传统钛网重建的患者与接受相同切除但使用个性化AVB的患者的内固定情况。
我们进行了一项回顾性比较研究，纳入了一家机构的C2椎体肿瘤患者队列。回顾了临床数据和影像学检查结果。通过数据处理和比较分析，我们描述并讨论了手术切除的可行性和安全性以及硬件植入物的结果。本研究的主要结果是内固定情况。
招募的31例患者分为两组。A组13例患者接受传统钛网重建，B组18例患者接受个性化AVB。所有患者均接受了分期的前后路手术。在该队列中，9.7%的患者实现了肿瘤整块切除，其余90.3%的患者实现了次全切除。围手术期并发症发生率和死亡率分别为45.2%和6.5%。围手术期并发症的发生与前路手术的选择有关（P<0.05）。A组的并发症发生率高于B组（P<0.05）。4例患者（4/13，30.8%）在随访期间出现硬件问题；然而，该比例略高于B组（1/18，5.6%）。
C2椎体肿瘤的全切除与围手术期并发症的高风险相关。分期后路和咽后入路是治疗C2肿瘤的较好手术策略。个性化AVB可以提供可靠的重建结果，但仍存在一些小问题，需要进一步改进。
