title: An Approach to Primary Tumors of the Upper Cervical Spine With Spondylectomy Using a Combined Approach: Our Experience With 19 Cases.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  To examine the link between major complications, surgical techniques, and perioperative care in the intralesional spondylectomy of the upper cervical spine.
  
  
  BACKGROUND
  Spondylectomy has been demonstrated to prolong cancer-free survival in many patients with locally aggressive spinal tumors. However, the challenging nature of this surgical procedure and the potential for severe complications often limit its application in the upper cervical spine.
  
  
  METHODS
  Nineteen patients with primary upper cervical tumors were treated with spondylectomy from March 2005 to August 2009, using either the anterior-posterior or posterior-anterior approach. Anterior procedures were transmandibular, transoral, or high retropharyngeal. Anterior reconstructions were performed in plates with iliac crest strut grafts, plates with mesh cages, and Harms mesh cages alone. Occipitocervical fixation was performed with Halo-vest application for postoperative immobilization.
  
  
  RESULTS
  Vertebral artery injuries occurred unilaterally in 5 cases intraoperatively: 4 occurred in the anterior approach of anterior-posterior procedures. Fusion was achieved in 9 patients with intact internal instrumentation. Fusion with the anterior construct in a tilted position occurred in 3 patients, all of whom underwent anterior-posterior procedures with Halo-vest immobilization for less than 1 month. Nonunion occurred in 3 cases after the posterior-anterior procedure because of anterior bone graft absorption. Prolonged Halo-vest immobilization maintained postoperative stability. Failure of internal instrumentation occurred in 3 cases. Anterior construct dislocation and severe tilting occurred in 2 cases after the anterior-posterior procedure. Five patients had a local recurrence. All recurrent lesions were malignant tumors and occurred in regions where surgical exposure was inadequate with incomplete excision.
  
  
  CONCLUSIONS
  The order of the surgical approach is a critical determinant of complications, fusion rates, choice of surgical technique, and reconstruction methods. The postoperative use of a Halo-vest is recommended. Local recurrence is associated with tumor malignancy and inadequate excision margin.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wei
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Zhongjun
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Gengting
authors.initials: G
authors.lastname: Dang
authors.affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center, NYU Hospital for Joint Diseases, NYU School of Medicine, Brooklyn Heights, NY.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Miao
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Fengliang
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Dang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D013125:Spinal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult