European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2014
Management of a major atlanto-axial instability secondary to a lytic lesion of C2.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Bourghli Anouar, Luc Stéphane, Obeid Ibrahim, Guérin Patrick, Gille Olivier, Vital Jean-Marc, Boissière Louis, Pointillart Vincent
Аннотация
INTRODUCTION: Management of C1-C2 instability is very challenging, especially when tumoral lesions are involved.
CASE REPORT: We present the case of a 65-year-old male, with a recently discovered small cell lung carcinoma, presenting progressive tetraparesis due to a secondary lesion involving the body of C2 with complete collapse of its anterior part and major C1-C2 instability in all planes. The patient underwent a reconstructive surgery of the upper cervical spine during two sessions. First, an emergency surgery was done by a high anterior cervical approach, where reconstruction of the body of C2 was done by an original technique using a C3 body to odontoid long screw with bone cement filling around the screw at the level of C2, and an anterior buttress plate put from C2 to C4. A posterior surgery was performed after 48 h to stabilize the spine posteriorly with C1 to C5 instrumentation. The patient recovered from his neurological symptoms, and underwent complementary adjuvant radiotherapy with chemotherapy later on.
CONCLUSION: Literature is sparse on the treatment of major C1-C2 instability, especially when a secondary lesion is involved, the current case shows a successful treatment strategy with an original technique that was never described before in the literature. The patient was pain free at 1 year follow-up with a stable construct.
CASE REPORT: We present the case of a 65-year-old male, with a recently discovered small cell lung carcinoma, presenting progressive tetraparesis due to a secondary lesion involving the body of C2 with complete collapse of its anterior part and major C1-C2 instability in all planes. The patient underwent a reconstructive surgery of the upper cervical spine during two sessions. First, an emergency surgery was done by a high anterior cervical approach, where reconstruction of the body of C2 was done by an original technique using a C3 body to odontoid long screw with bone cement filling around the screw at the level of C2, and an anterior buttress plate put from C2 to C4. A posterior surgery was performed after 48 h to stabilize the spine posteriorly with C1 to C5 instrumentation. The patient recovered from his neurological symptoms, and underwent complementary adjuvant radiotherapy with chemotherapy later on.
CONCLUSION: Literature is sparse on the treatment of major C1-C2 instability, especially when a secondary lesion is involved, the current case shows a successful treatment strategy with an original technique that was never described before in the literature. The patient was pain free at 1 year follow-up with a stable construct.