Innovative Technique of Anchoring the Upper End of the Cervical Plate With C1 Anterior Arch Screw for Upper Cervical Tumors.

Background and objectives: Upper cervical spine bony tumors pose a challenge to surgeons because of their extensiveness and proximity to vital structures. Reconstruction following resection is necessary to prevent instability. Our objective is to describe a technical note on the C1 anterior arch screw with mesh cage reconstruction for anchoring the upper end of the cervical plate after resection of the upper cervical tumor.

Methods: A retrospective review of patients with primary bony tumors of the upper cervical spine after surgical resection between 2018 and 2022 was included in the study. Imaging workup included computed tomography, MRI, and computed tomography angiogram.

Results: A total of 4 patients with primary bony tumors of the upper cervical spine underwent C1 anterior screw fixation with mesh cage reconstruction. The mean age was 33.8 ± 14.3 years. Tumor extent was C2-C4 in 2 patients (50%) and C2 in 2 patients (50%). Three patients had a spinal instability neoplastic score of >12 and were deemed unstable preoperatively, mandating the stabilization procedure. All patients underwent surgical resection: gross total resection (1, 25%), near-total excision (1, 25%), and tumor decompression (2, 50%). Surgery was staged in 3 patients (75%) because of the extensiveness of the tumor and massive blood loss. There was no perioperative mortality. The mean postoperative Nurick grading score was 1.5 ± 1.3 (range 0-3). All patients were ambulatory and showed neurological improvement postoperatively with a mean follow-up of 37.5 ± 21.9 months and evidence of fusion on the latest imaging.

Conclusion: Radical resection of tumors involving the upper cervical spine requiring C2 corpectomy is challenging. En bloc resection is not always feasible. Neurosurgeons can consider using the anterior arch as an anchor point. The use of neuronavigation facilitates the precise placement of the C1 arch screws.