Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 62-70
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.62
Surgical resection of intradural extramedullary tumors in the atlantoaxial spine via a posterior approach
Di-Hua Meng, Jia-Qi Wang, Kun-Xue Yang, Wei-You Chen, Cheng Pan, Hua Jiang
Di-Hua Meng, Jia-Qi Wang, Kun-Xue Yang, Wei-You Chen, Cheng Pan, Hua Jiang, Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
Author contributions: Jiang H conceived, supervised the study and performed critical revision of the manuscript; Meng DH and Wang JQ were involved in the data search and selection of data; Yang KX, Pan C and Chen WY analyzed and interpreted the data and drafted the manuscript; All authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81860406; Guangxi Natural Science Foundation, No. 2018GXNSFAA281127; and Medical Excellence Award Funded by the Creative Research Development Grant from The First Affiliated Hospital of Guangxi Medical University.
Institutional review board statement: The histological study of surgical samples was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (No. 2020-KY-NSFC-025).
Informed consent statement: Written consent was obtained from each participant.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua Jiang, MD, PhD, Professor, Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Province, China. drjianghua@163.com
Received: May 3, 2021
Peer-review started: May 3, 2021
First decision: October 16, 2021
Revised: October 30, 2021
Accepted: November 19, 2021
Article in press: November 19, 2021
Published online: January 7, 2022
Processing time: 241 Days and 5.5 Hours
Abstract
BACKGROUND

The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary (IDEM) tumors. Studies concerning surgical interventions via a posterior approach are limited.

AIM

To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.

METHODS

We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018. The analyzed data included tumor position, histopathological type, pre- and post-operative Japanese Orthopedic Association (JOA) scores and Nurick grades, postoperative complication and recurrence status.

RESULTS

A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study. In all cases reviewed, total tumor resection and concomitant C1-C2 fusion were achieved. The average follow-up was 35.3 ± 6.9 mo (range, 26-49 mo). A statistically significant difference was noted between the preoperative JOA score (11.2 ± 1.1) and the score at the last final follow-up (15.6 ± 1.0) (P < 0.05). A statistically significant difference was noted between the preoperative Nurick grade (2.3 ± 0.9) and that at the last follow-up (1.2 ± 0.4) (P < 0.05). However, no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle (P > 0.05). No mortalities, severe complications or tumor recurrence were observed during the follow-up period.

CONCLUSION

Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach. Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.

Keywords: Atlantoaxial spine, Cervical spine, Extramedullary tumors, Intardural tumer, Posterior approach, Surgical resection

Core Tip: This retrospective study investigated the safety and efficacy of atlantoaxial intradural extramedullary (IDEM) tumor resection using a one-stage posterior approach. Statistically significant differences were noted between the preoperative Japanese Orthopedic Association (JOA) score and Nurick grade and those at the last follow-up (JOA: 11.2 ± 1.1 vs 15.6 ± 1.0; Nurick grade: 2.3 ± 0.9 vs 1.2 ± 0.4; all P < 0.05). No mortalities, severe complications or tumor recurrence were observed during the follow-up period. Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.