Masayuki Nakahara1, Kenki Nishida2, Shinji Kumamoto2, Yasukazu Hijikata2, Kei Harada3. 1. Department of Spinal Surgery, Fukuoka Wajiro Hospital, 2-75 Wajirogaoka, Higashi-ku, Fukuoka, Fukuoka, 811-0213, Japan. n-masayuki@hotmail.com. 2. Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan. 3. Department of Neuro Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan.
Abstract
PURPOSE: To describe the surgical experience of spondylectomy and spinal reconstruction for aggressive vertebral hemangioma (VH) induced at the C4 vertebra. No reports have described surgical strategy in cases covering an entire cervical vertebra presenting with progressive myelopathy. METHODS: A 28-year-old man presented with rapidly progressing skilled motor dysfunction and gait disorder. The Japanese Orthopedic Association (JOA) score was 6. Radiography showed a honeycomb appearance for the entire circumference of the C4 vertebra. Spinal computed tomography and magnetic resonance imaging showed vertebral tumor with extraosseous extension causing spinal cord compression. Results of diagnostic imaging were strongly suggestive of VH. Transarterial embolization of the spinal body branch was performed first to decrease intraoperative bleeding, followed by cervical posterior fixation to stabilize the unstable segment and excision biopsy to obtain a definitive diagnosis. After definitive diagnosis of cavernous hemangioma, two-stage surgery (anterior and posterior) was performed to complete total spondylectomy and 360° spinal reconstruction. RESULTS: Despite multiple operations, JOA scores were 8.5 after posterior fixation, 10.5 after anterior surgery, 11 after final surgery and 16 on postoperative day 90. The patient acquired excellent clinical results without complications and returned to society. CONCLUSIONS: The present three-stage surgery comprising fixation, biopsy, and final spondylectomy with circumferential fusion from anterior and posterior approaches may offer a useful choice for aggressive VH covering the entire cervical spine with rapidly progressive myelopathy.
PURPOSE: To describe the surgical experience of spondylectomy and spinal reconstruction for aggressive vertebral hemangioma (VH) induced at the C4 vertebra. No reports have described surgical strategy in cases covering an entire cervical vertebra presenting with progressive myelopathy. METHODS: A 28-year-old man presented with rapidly progressing skilled motor dysfunction and gait disorder. The Japanese Orthopedic Association (JOA) score was 6. Radiography showed a honeycomb appearance for the entire circumference of the C4 vertebra. Spinal computed tomography and magnetic resonance imaging showed vertebral tumor with extraosseous extension causing spinal cord compression. Results of diagnostic imaging were strongly suggestive of VH. Transarterial embolization of the spinal body branch was performed first to decrease intraoperative bleeding, followed by cervical posterior fixation to stabilize the unstable segment and excision biopsy to obtain a definitive diagnosis. After definitive diagnosis of cavernous hemangioma, two-stage surgery (anterior and posterior) was performed to complete total spondylectomy and 360° spinal reconstruction. RESULTS: Despite multiple operations, JOA scores were 8.5 after posterior fixation, 10.5 after anterior surgery, 11 after final surgery and 16 on postoperative day 90. The patient acquired excellent clinical results without complications and returned to society. CONCLUSIONS: The present three-stage surgery comprising fixation, biopsy, and final spondylectomy with circumferential fusion from anterior and posterior approaches may offer a useful choice for aggressive VH covering the entire cervical spine with rapidly progressive myelopathy.
Authors: Eugenio Rimondi; Eric L Staals; Costantino Errani; Giuseppe Bianchi; Roberto Casadei; Marco Alberghini; Maria Cristina Malaguti; Giuseppe Rossi; Stefano Durante; Mario Mercuri Journal: Eur Spine J Date: 2008-05-08 Impact factor: 3.134
Authors: Frank L Acosta; Christopher F Dowd; Cynthia Chin; Tarik Tihan; Christopher P Ames; Philip R Weinstein Journal: Neurosurgery Date: 2006-02 Impact factor: 4.654