Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases

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Effective en bloc resection of primary spinal tumors necessitates careful consideration of adjacent anatomical structures in order to achieve negative margins and reduce surgical morbidity. This can be particularly challenging in the cervical spine, where vital neurovascular and connective tissues are present in the region. Early multidisciplinary surgical planning that includes clinicians and engineers can both optimize surgical planning and enable a more feasible resection with oncological margins. The aim of the current work was to demonstrate two cases that involved multidisciplinary surgical planning for en bloc resection of primary cervical spine tumors, successfully utilizing 3D-printed patient models and neoadjuvant therapies.

ABBREVIATIONS SBRT = stereotactic body radiation therapy.

Article Information

Correspondence Daniel M. Sciubba: Johns Hopkins School of Medicine, Baltimore, MD. dsciubb1@jhmi.edu.

INCLUDE WHEN CITING Published online January 18, 2019; DOI: 10.3171/2018.9.SPINE18607.

Disclosures The 3D-printed models were acquired from a partnership between K2M and 3D Systems (K2M/3D Systems Partnership) and DePuy Synthes Spine.

Dr. Sciubba is a consultant for Medtronic, DePuy Synthes Spine, Stryker, NuVasive, K2M, and Baxter.

This manuscript does include off-label use of spinal instrumentation, including mesh cages in the cervical spine, and posterior cervical screws.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Preoperative imaging of a young patient with a myxoid liposarcoma extending from C4 to T1. A: Sagittal MR image. B: Axial MR image. C: Sagittal MR image following 6 rounds of neoadjuvant chemotherapy. D: Axial MR image following 6 rounds of neoadjuvant chemotherapy. E: 3D-printed spine model constructed from preoperative imaging. Asterisks indicate the tumor.

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    Case 1. Intraoperative imaging of stage I (posterior). A: Posterior osteotomy across C4–T1. B: Instrumented arthrodesis from C2 to T3. C: Preoperative axial MR images for comparison. D: Postoperative axial MR images demonstrating osteotomies across vertebral bodies of C4–T1 and posterior instrumentation. E: Coronal CT scan demonstrating posterior instrumented arthrodesis from C2 to T3.

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    Case 1. Intraoperative neck dissection of stage II (anterior). A: The patient was placed supine, draped, and prepared. B: Neck dissection was carried down to the tumor. C: Neuronavigation was utilized throughout the procedure. D and E: The tumor was released and resected en bloc. F and G: Anterior column reconstruction from C3 to T2 with a structural fibular graft. H: Postoperative lateral radiograph.

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    Case 2. Preoperative imaging of a 55-year-old man with a cervical chordoma, most prominent at C2–3. A: Preoperative sagittal MR image. B: Preoperative axial MR image. C: Sagittal MR image following neoadjuvant SBRT. D: Axial MR image following neoadjuvant SBRT. E and F: 3D-printed spine model constructed from preoperative images. Asterisks indicate the tumor.

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    Case 2. Operative techniques and postoperative images. A–C: Stage I involved posterior decompression and instrumented arthrodesis from C1 to T2. D–G: Stage II involved anterior total en bloc tumor resection, including the C2 and C3 vertebral bodies. H–J: Anterior column reconstruction with cage placement and structural fibular allograft. K: Revision surgery for wound infection and dehiscence, with removal of the anterior cage and extension of the posterior instrumentation from the occiput to T3.

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