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Modified paramedian transpedicular approach and spinal reconstruction for intradural tumors of the cervical and cervicothoracic spine: clinical experience.
Spine (Phila Pa 1976). 2007 Mar 15; 32(6):E203-10.S

Abstract

STUDY DESIGN

Retrospective review of the medical, radiographic, surgical, and postoperative records of patients who underwent resection of multilevel intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine via a modified paramedian transpedicular approach at the University of California, San Francisco, between 2003 and 2005.

OBJECTIVE

To assess the surgical, clinical, and radiographic outcomes of using the modified paramedian transpedicular approach to resect ventral intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine.

SUMMARY OF BACKGROUND DATA

A common theme of skull-base surgery for many years has been to remove the bone rather than retract neural elements. In this report, we demonstrate some possible advantages of taking a "spine-base" approach for resecting intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spinal canal, and present our clinical experience.

METHODS

All medical, surgical, and radiologic records were retrospectively reviewed. Clinical outcome was assessed for disability via the Neck Disability Index and for pain via the visual analog scale.

RESULTS

Fourteen patients (4 males and 10 females, average age 39.6 years, range 20-62) with intradural extramedullary spinal cord tumors involving multiple levels of the anterior cervical and cervicothoracic spine were identified. All patients presented with pain and/or radiculomyelopathy attributed to a ventral intradural extramedullary spinal cord tumor of the cervical or cervicothoracic spine that was resected via the modified paramedian transpedicular approach with partial dorsal corpectomy and posterior spinal reconstruction. The average follow-up period was 14.6 months (range 5-30). Gross total resection was achieved in all cases, and no patient required additional surgery via an anterior approach for residual tumor.

CONCLUSIONS

The modified paramedian transpedicular approach with partial dorsal corpectomy we describe here is a variation of traditional thoracic posterolateral transpedicular extracavitary approaches and offers direct access to lesions of the ventral cervicothoracic spinal canal. This approach avoids the morbidity of anterior transcervical, transoral, or transthoracic procedures, while providing a view of the entire ventral cervicothoracic canal, and can be performed safely and effectively in select patients.

Authors+Show Affiliations

Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17413461

Citation

Acosta, Frank L., et al. "Modified Paramedian Transpedicular Approach and Spinal Reconstruction for Intradural Tumors of the Cervical and Cervicothoracic Spine: Clinical Experience." Spine, vol. 32, no. 6, 2007, pp. E203-10.
Acosta FL, Aryan HE, Chi J, et al. Modified paramedian transpedicular approach and spinal reconstruction for intradural tumors of the cervical and cervicothoracic spine: clinical experience. Spine (Phila Pa 1976). 2007;32(6):E203-10.
Acosta, F. L., Aryan, H. E., Chi, J., Parsa, A. T., & Ames, C. P. (2007). Modified paramedian transpedicular approach and spinal reconstruction for intradural tumors of the cervical and cervicothoracic spine: clinical experience. Spine, 32(6), E203-10.
Acosta FL, et al. Modified Paramedian Transpedicular Approach and Spinal Reconstruction for Intradural Tumors of the Cervical and Cervicothoracic Spine: Clinical Experience. Spine (Phila Pa 1976). 2007 Mar 15;32(6):E203-10. PubMed PMID: 17413461.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified paramedian transpedicular approach and spinal reconstruction for intradural tumors of the cervical and cervicothoracic spine: clinical experience. AU - Acosta,Frank L,Jr AU - Aryan,Henry E, AU - Chi,John, AU - Parsa,Andrew T, AU - Ames,Christopher P, PY - 2007/4/7/pubmed PY - 2007/4/27/medline PY - 2007/4/7/entrez SP - E203 EP - 10 JF - Spine JO - Spine (Phila Pa 1976) VL - 32 IS - 6 N2 - STUDY DESIGN: Retrospective review of the medical, radiographic, surgical, and postoperative records of patients who underwent resection of multilevel intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine via a modified paramedian transpedicular approach at the University of California, San Francisco, between 2003 and 2005. OBJECTIVE: To assess the surgical, clinical, and radiographic outcomes of using the modified paramedian transpedicular approach to resect ventral intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine. SUMMARY OF BACKGROUND DATA: A common theme of skull-base surgery for many years has been to remove the bone rather than retract neural elements. In this report, we demonstrate some possible advantages of taking a "spine-base" approach for resecting intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spinal canal, and present our clinical experience. METHODS: All medical, surgical, and radiologic records were retrospectively reviewed. Clinical outcome was assessed for disability via the Neck Disability Index and for pain via the visual analog scale. RESULTS: Fourteen patients (4 males and 10 females, average age 39.6 years, range 20-62) with intradural extramedullary spinal cord tumors involving multiple levels of the anterior cervical and cervicothoracic spine were identified. All patients presented with pain and/or radiculomyelopathy attributed to a ventral intradural extramedullary spinal cord tumor of the cervical or cervicothoracic spine that was resected via the modified paramedian transpedicular approach with partial dorsal corpectomy and posterior spinal reconstruction. The average follow-up period was 14.6 months (range 5-30). Gross total resection was achieved in all cases, and no patient required additional surgery via an anterior approach for residual tumor. CONCLUSIONS: The modified paramedian transpedicular approach with partial dorsal corpectomy we describe here is a variation of traditional thoracic posterolateral transpedicular extracavitary approaches and offers direct access to lesions of the ventral cervicothoracic spinal canal. This approach avoids the morbidity of anterior transcervical, transoral, or transthoracic procedures, while providing a view of the entire ventral cervicothoracic canal, and can be performed safely and effectively in select patients. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/17413461/Modified_paramedian_transpedicular_approach_and_spinal_reconstruction_for_intradural_tumors_of_the_cervical_and_cervicothoracic_spine:_clinical_experience_ DB - PRIME DP - Unbound Medicine ER -