Spine Center of East Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Arch Orthop Trauma Surg. 2024 Jun;144(6):2547-2552. doi: 10.1007/s00402-024-05386-3. Epub 2024 May 22.
Pathological destruction of the axis vertebra leads to a highly unstable condition in an upper cervical spine. As surgical resection and anatomical reconstruction of the second cervical vertebrae represents a life threatening procedure, less radical approaches are preferred and only few cases of C2 prosthesis are described in literature.
The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed CONCLUSION: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection.
轴状脊椎的病理性破坏会导致上颈椎极不稳定。由于第二颈椎的手术切除和解剖重建是一项危及生命的手术,因此倾向于采用较少激进的方法,文献中仅描述了少数几例 C2 假体病例。
本病例报告的重点是一名 21 岁男性,因 C2 病理性骨折,最初通过 C1-C3 背侧融合进行手术治疗。由于巨细胞瘤的进展和轴状脊椎的破坏,通过前路进行 C2 假体置换,并进行 C0-C4 后路枕颈融合。术后感染通过两阶段的背侧清创、骨合成材料更换和自体骨移植进行手术治疗。在静脉注射头孢曲松联合阿莫西林/克拉维酸 4 周后,改为口服阿莫西林/克拉维酸联合环丙沙星 12 周,感染完全恢复。在最后一次修正手术后 2 个月开始放疗,患者在 1 年随访时表现出良好的临床结果和稳定的结构。对所有报告的 C2 假体病例进行了文献回顾。
C2 假体允许在涉及轴状脊椎的病理性过程中进行更激进的切除。与后路融合相结合,可立即获得稳定性。前路手术通过高度不无菌的口腔环境进行,术后感染风险高。