title: Novel reconstruction of the anterior craniocervical junction using an expandable cage with integrated fixation after total C2 spondylectomy for chordoma.
abstract: Chordoma is a locally aggressive malignant tumor that generally occurs in the clivus, mobile spine and sacrum. While en bloc resection with wide margins has been advocated as the only cure for chordomas, tumor characteristics and violation of critical anatomical boundaries may preclude pursuing this treatment option in the cervical spine. We present a C2 chordoma in a 35-year-old man with epidural and prevertebral extension that was treated with a single stage anterior-posterior total C2 spondylectomy with novel reconstruction using an expandable cage with integrated fixation followed by stereotactic radiosurgery. Single stage intralesional total C2 spondylectomy via anterior transoral and posterior approaches was performed. The anterior column was reconstructed using an expandable cage with integrated fixation from the clivus to C3. The patient maintained his intact neurological status at 6 month follow-up with full resumption of activities of daily living without any significant morbidity.
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA. Electronic address: Joshua_T_Wewel@rush.edu.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Wewel
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Nunna
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Kasliwal
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: O'Toole
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002817:Chordoma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data; D008297:Male; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Axis; C2; Chordoma; Expandable cage; Spondylectomy; Transoral approach