Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 644-650
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.644
Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review
Li-Ming He, Xun Ma, Chen Chen, Hong-Yi Zhang
Li-Ming He, Xun Ma, Chen Chen, Hong-Yi Zhang, Department of Orthopedics, Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
Author contributions: Ma X designed the study; He LM wrote the manuscript; Chen C was responsible for following up the patient and collecting the data; He LM and Zhang HY reviewed the literature; Ma X revised the manuscript.
Supported by Shanxi Science and Technology Department, No. 201604D132044.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xun Ma, MD, Professor, Department of Orthopedics, Bethune Hospital Affiliated to Shanxi Medical University, No. 99 Longcheng Street, Taiyuan 030032, Shanxi Province, China. 44156254@qq.com
Received: August 30, 2020
Peer-review started: August 30, 2020
First decision: November 8, 2020
Revised: November 18, 2020
Accepted: December 6, 2020
Article in press: December 6, 2020
Published online: January 26, 2021
Processing time: 140 Days and 21.9 Hours
Abstract
BACKGROUND

Cervical spondylectomy for the treatment of cervical tumors is traumatic, causes bleeding, and is risky. This study reports on the experience with minimally invasive cervical spondylectomy for a cervical metastasis and reviewed the literature on cervical spondylectomy. The purpose was to reduce the risk and trauma of spondylectomy.

CASE SUMMARY

A 60-year-old woman presented with cervical pain and radiating pain in the left upper limb for more than 2 mo. Preoperative diagnosis was C4 metastasis of thyroid cancer. Preoperative visual analogue scale score was 5. American Spinal Cord Injury Association (ASIA) grade was E. Tomita classification was 7. Weinstein-Boriani-Biagini (WBB) classification was A-D, 3-9. Tomita score was 5. Modified Tokuhashi score was 9. Spinal instability neoplastic score (SINS) was 13. The patient underwent minimally invasive cervical spondylectomy on September 28, 2017. The operative time was 200 min; the estimated blood loss was 1200 mL. The operation was successful, without complications. The postoperative visual analogue scale score was 0. The patient remained classified as ASIA grade E at the last follow-up. She accepted regular iodine-131 therapy postoperatively. The serum thyroglobulin (Tg) level of this patient was 299.02 ng/mL at 1 mo after the operation and was 13.57 ng/mL at the last follow-up. There was no local recurrence at the 25-mo follow-up, according to images, single-photon emission computed tomography, and serum Tg levels. Obvious ossification and solid fusion of C3-C5 were found at the last follow-up.

CONCLUSION

Minimally invasive cervical spondylectomy with tubular retractor could minimize soft tissue trauma, intraoperative traction injury, and paraspinal muscle injury, accelerating postoperative recovery. This technique requires a rich experience in cervical spine surgery with tubular retractors, so that surgeons can visualize the anatomical structure in a small field.

Keywords: Minimally invasive; Cervical; Spondylectomy; Tubular retractor; Thyroid carcinoma; Case report

Core Tip: Cervical spondylectomy for the treatment of cervical tumors is traumatic, causes bleeding, and is risky. We report a case of 60-year-old woman with C4 metastasis of thyroid carcinoma after thyroidectomy. The patient underwent minimally invasive spondylectomy through tubular retractors. The purpose of the procedure was to reduce surgical trauma and risks. After the operation, the patient was treated with iodine-131. There was no local recurrence, and achievement of solid fusion was detected at last follow-up. This study shows that minimally invasive spondylectomy is feasible in patients who are not candidates for total en bloc spondylectomy, and could reduce the surgical trauma and risks.