Case Report: Does the misplaced titanium mesh cage after total spondylectomy causing cervicothoracic cord compression need to be removed during revision surgery?

IF 1.6 4区 医学 Q2 SURGERY
Frontiers in Surgery Pub Date : 2024-10-17 eCollection Date: 2024-01-01 DOI:10.3389/fsurg.2024.1394135
Xin Wang, XiaoFei Cheng, Jie Zhao, ChangQing Zhao
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引用次数: 0

Abstract

Background: Mechanical failure following total spondylectomy is a surgical challenge. The cervicothoracic junction region is a special anatomical site with complex biomechanics, and few studies have reported a detailed surgical management strategy for cases where the mesh cage subsides and compresses the spinal cord in the cervicothoracic junction region after total spondylectomy.

Case presentation: A 56-year-old male patient experienced screw and rod fracture and mesh cage retropulsion into the spinal canal 5 years after total spondylectomy for osteochondroma in the first to third thoracic vertebrae. The patient complained of numbness and discomfort in both lower extremities, accompanied by unstable walking for 8 months prior to admission at our hospital. We concluded that uncorrected local kyphosis in the cervicothoracic junction after the first surgery resulted in current mesh cage subsidence and rod/screw fracture. Considering the difficulty and risks of removing the mesh cage from the anterior approach, we initially freed the superior end of the mesh cage without removing the mesh from the anterior approach by resecting the C6/7 intervertebral disc and the destroyed C7 vertebral body. We then removed the original screws and rods and performed long segment fixation from C4 to T6 via a posterior approach after recovering sagittal alignment by skull traction. Finally, the iliac bone was harvested and transplanted between the superior end of the mesh cage and the inferior end plate of C6 to fill the defect caused by kyphosis correction and C7 vertebral resection. After surgery, the patient experienced sagittal alignment reconstruction and symptom relief, and he was asked to wear a cast for at least 6 months until bone fusion was achieved. At the 3-year follow-up, there was fusion between the mesh cage and the C6 vertebra with successful instrument reconstruction and no mesh cage subsidence were observed.

Conclusions: When a subsided and migrated titanium mesh cage is difficult to remove after mechanical failure following total spondylectomy, recovering sagittal alignment to achieve indirect decompression based on unique anterior and middle column reconstruction, solid instrument construction, and bone fusion is an alternative solution.

病例报告:全脊椎切除术后错位的钛网笼导致颈胸脊髓压迫,翻修手术时需要取出吗?
背景:全脊柱切除术后的机械损伤是一项外科难题。颈胸交界区是一个特殊的解剖部位,具有复杂的生物力学特性,对于全脊椎切除术后网笼下沉并压迫颈胸交界区脊髓的病例,很少有研究报道详细的手术处理策略:一名 56 岁的男性患者因第一至第三胸椎骨软骨瘤接受全脊椎切除术 5 年后,出现螺钉和杆骨折以及网笼后入椎管的情况。患者主诉双下肢麻木不适,伴有行走不稳,入院前已持续 8 个月。我们的结论是,第一次手术后未纠正的颈胸交界处的局部后凸导致了目前的网笼下沉和杆/螺钉断裂。考虑到从前路取出网笼的难度和风险,我们首先通过切除C6/7椎间盘和被破坏的C7椎体,在不从前路取出网笼的情况下释放了网笼的上端。然后,我们移除了原有的螺钉和螺杆,在通过颅骨牵引恢复矢状位对齐后,通过后路进行了从C4到T6的长节段固定。最后,我们采集了髂骨,并将其移植到网笼的上端和C6的下端钢板之间,以填补后凸矫正和C7椎体切除造成的缺损。术后,患者的矢状排列得到重建,症状得到缓解,患者被要求穿戴石膏至少6个月,直到实现骨融合。3年随访时,网笼与C6椎体融合,器械重建成功,未观察到网笼下沉:结论:当全脊椎切除术后机械故障导致钛网笼下沉和移位难以取出时,基于独特的前柱和中柱重建、坚固的器械结构和骨融合,恢复矢状对齐以实现间接减压是一种替代解决方案。
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来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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