Posterior Instrumentation Combined With Anterior Transoral Approach For The Treatment Of Tumor Involving The Upper Cervical Spine: A Retrospective Study

Background: We investigated retrospectively the clinical outcomes of surgical treatment of tumors involving the the upper cervical spine in our center,summarized and analyzed clinical information in order to provide a satisfactory strategy for treatment of tumors involving the upper cervical spine.Methods: Between August 2015 and August 2018,5 patients(five males)pathologically diagnosed with axis tumor were treated at our hospital.Their age ranges from 16 to 67 years,with an average age of(46.4±18).There were 2 case of fibrous histiocytoma of bone,1 case was osteolipoma,1 case was giant cell tumor,and 1 case was metastatic adenocarcinoma of lung.Weinstein-Boriani-Biagini anatomic zone classification and Tokuhashi scoring system were used for staging.The Japanese Orthopaedic Association(JOA)scores of cervical cord and the visual analog scale(VAS)scores for pain were assessed pre-and postoperatively to evaluate the change of neurological function.We performed posterior instrumentation combined with lesional resection through the transoral approach to treat the axis tumor.The clinical history,preoperative and postoperative imaging data,operation time,blood loss,complications and therapeutic effect were recorded and analyzed.Results: Five patients were followed for 12-34 months;the mean follow-up time was(22.6±7.3)months.The scores of JOA[(15±1.5)points vs(11.2±2.9)points] and VAS[(1.6±0.8)points vs(6.4±0.5)points] changed significantly at 3 months postoperatively.The results of CT scanning at 6-month follow-up showed that the implanted autogenous iliac had fused with surrounding bone tissues successfully.Five patients except case(3)survived with no recurrence and metastasis during follow-up period.The last follow-up in August 2018 showed loosening or failure of internal fixation were not observed in all patients.Conclusion: This surgical strategy,posterior instrumentation combined with anterior transoral lesional resection provides satisfactory outcomes for treating the axis tumors,relieving intractable pain,restoring or improving neurologic function,stabilizing the cervical spine,and prolonging patient survival.