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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

C2-C3 replacement surgery – a technical note and review of the literature

HWK2-3 Wirbelkörperersatz – Operationstechnik und Literaturübersicht

Meeting Abstract

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  • presenting/speaker Sami Ridwan - Evangelisches Klinikum Bethel, Neurochirurgie, Bielefeld, Deutschland
  • Alexander Grote - Evangelisches Klinikum Bethel, Neurochirurgie, Bielefeld, Deutschland
  • Matthias Simon - Evangelisches Klinikum Bethel, Neurochirurgie, Bielefeld, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP202

doi: 10.3205/20dgnc487, urn:nbn:de:0183-20dgnc4872

Published: June 26, 2020

© 2020 Ridwan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objective: Anterior C2 replacement alone or in combination with C3 is infrequently performed in daily neurosurgical practice. Here we report an illustrative case and a review of the literature.

Methods: A 24-year old male presented with acute tetraparesis after suffering a stair fall. Initial CT Imaging revealed partial osteolysis of C2 and 3. Subsequent MRI showed additional spinal cord compression due to a ventral epidural mass. Emergency dorsal decompression and instrumentation surgery was performed. Motor function improvement (mild upper limb paresis) was rapid and almost complete. The histological work-up revealed an osteoblastoma. We felt that definitive surgical management was mandatory. A posterior release through rod removal was performed, followed by a high anterior ventral approach to C2-3 with corpectomy and fusion using a screw fixated custom-made mesh-implant and finally posterior fixation C1-7. Given the patient’s young age, initial C0-7 instrumentation was reduced to C1-7. A review of the literature was performed.

Results: Postoperative imaging confirmed complete resection and proper implant placement and alignment. We found 10 reports with 1-11 cases in the pertinent literature addressing this matter. All described combined anterior-posterior approaches. A few described the high anterior cervical approach used in this case, others performed transmandibular or transoral surgery. One reported additional Halo-Fixation. Fusion techniques included autologous bone grafts or mesh-implants with or without anterior fixation. Revision and fusion rates were up to 14% and ≥ 90% respectively. A high anterior cervical approach and custom-made mesh-implants with additional screw fixation may offer some advantages over more traditional surgical management strategies.

Conclusion: A high anterior cervical approach for C2-3 replacement utilizing a screw fixated custom-made mesh-implant can be performed without a transmandibular or transoral approach with satisfying results possibly reducing surgical morbidity. We feel that a combined approach with additional posterior fixation is mandatory.