Article thumbnail

Surgical resection of neoplastic cervical spine lesions in relation to the vertebral artery V2 segment

By Mohamed Al Barbarawi, Ziad Odat, Mwaffaq Alheis, Suhair Qudsieh and Tareq Qudsieh


Neoplastic cervical spine lesions are seen infrequently by the spinal surgeon. The surgical management of these tumors, particularly with associated neurovascular compromise, is challenging in terms of achieving proper resection and spinal stabilization and ensuring no subsequent recurrence or failure of fixation. In this report we highlight some of the problems encountered in the surgical management of tumors involving the cervical spine with techniques applied for gross total resection of the tumor without compromising the vertebral arteries. Ten patients with neoplastic cervical spine lesions were managed in our study. The common cardinal presentation was neck and arm pain with progressive cervical radiculo-myelopathy. All patients had plain X-rays, computer tomography scans, and magnetic resonance imaging of the cervical spine. Digital subtraction or magnetic resonance angiograms were performed on both vertebral arteries when the pathology was found to be in proximity to the vertebral artery. When a tumor blush with feeders was evident, endovascular embolization to minimize intraoperative bleeding was also considered. A single approach or a combined anterior cervical approach for corpectomy and cage-with-plate fixation and posterior decompression for resection of the rest of the tumor with spinal fixation was then accomplished as indicated. All cases made a good neurological recovery and had no neural or vascular complications. On the long-term follow-up of the survivors there was no local recurrence or surgical failure. Only three patients died: two from the primary malignancy and one from pulmonary embolism. This report documents a safe and reliable way to deal with neoplastic cervical spine lesions in proximity to vertebral arteries with preservation of both arteries

Topics: Article
Publisher: PAGEPress Publications
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. A safe approach to explore/identify the V(2) segment of the vertebral artery during anterior approaches to cervical spine and/or arterial repairs: anatomical study.
  2. A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine.
  3. American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section on Disorders of the Spine and Peripheral Nerves. Management of vertebral artery injuries after non-penetrating cervical trauma.
  4. Anterolateral approach to the V2 segment of the vertebral artery.
  5. Benign osteoblastoma of the odontoid process of the axis with secondary aneurysmal bone cyst component: a case report.
  6. Bone tumors at the cranio-cervical junction. Surgical management and results from a series of 41 cases.
  7. (1989). Diagnosis and management of tumours of the cervical spine. In: The Cervical Spine. The Cervical Spine Research Society Editorial Committee, 2nd edn.
  8. (1992). Diagnosis and surgical management of ossification of the posterior longitudinal liga ment. Contemp Neurosurg
  9. Giant Cell Tumor of the Cervical Spine: A Series of 22 Cases and Outcomes. Clinical Case Series.
  10. Giant cell tumors of the spine: a clinical study of six cases, with emphasis on the radiological features, treatment, and follow-up.
  11. Giant cell tumour of the sixth cervical vertebrae with close relationship to the vertebral artery.
  12. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases.
  13. (1991). Increased MR signal intensity due to cervical myelopathy: Analysis of 29 cases.
  14. (1995). Management of the vertebral artery in excision of extradural tumors of the cervical spine.
  15. (1996). Metastases to upper cervical spine.
  16. (1994). Osteoid osteoma or osteoblastoma of the cer -vical spine in relation to the vertebral artery. Pediatric Orthop
  17. Outcome of 132 operations in 97 patients with chordomas of the craniocervical junction and upper cer -vical spine. Neurosurgery 2010;66:59-65. Article [Neurology International 2010; 2:e11] [page 51]
  18. Preoperative embolization of cervical spine osteoblastomas: report of three cases.
  19. Preoperative evaluation of cervical radicu -lopathy and myelopathy by surface-coil MR imaging.
  20. Surgical management of chordomas of the cervical spine.
  21. (1993). The natural history and management of symptomatic and asymptom -atic vertebral hemangioma.
  22. The use of CT angiography in the preoperative planning of cervical spine surgery in children.
  23. (1993). Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients.
  24. (1993). Vertebral haemangioma symptomatic during pregnancy – report of a case and review of the literature.
  25. Vertebrectomy of giant cell tumor with vertebral artery embolization: case report.