Surgical methods: We are leading a posterior approach, posterior midline incision, take ilium implantation after pruning ring after vertebral arch and pivot between vertebral lamina, intraoperative shooting after upper cervical form certainly use each of the 2 titanium cable bypass ring after vertebral arch and fixed pivot vertebral lamina and pressurized, after percutaneous using 2 pieces of hollow screw from below to above before after posterior atlantoaxial pedicle and vertebra lateral mass fixation. The neck circumference will be protected after surgery, and the second operation is performed a week later. Navigation through oral cavity axis vertebral tumors resection under, take the ilium implantation cervical vertebral body position, then percutaneous avoid the trachea and esophagus using hollow screw by former direction after the above after cervical vertebral body 3 in front of the cortical bone and implant ilium to dentate central fixation\cite{Karthik2018,Inoue2018}.
Discussion: Spine is the most common part of malignant tumor transfer. It is commonly seen in thoracolumbar, followed by cervical vertebra and sacrum. Metastatic tumors of the cervical spine account for 8-20% of the metastatic tumors of the spine, while the proportion of the upper cervical spine is less [1] (Masala S, Guglielmi G, Petrella MC,2011).This is less likely to occur in atlantoaxial, accounting for only 0.5%\cite{Gokaslan1998}. Epistropheus centrum and adnexal bone tumor, due to its specific anatomical position and the complex biological functions of the centrum, surgery is very difficult and doesn’t have not many related reports. However, Atlantoaxial metastatic tumor is very dangerous and often leads to vertebral instability, collapse, pain and spinal cord compression. In severe cases may lead to high paralysis or even death. While treatment, it is necessary to consider the patient’s physical condition comprehensively, adopt surgical treatment to remove the tumor and improve the patient’s health condition.
The operation aims to achieve the following therapeutic goals: (1) control or relieve pain. (2) preserve or promote recovery of spinal cord and nerve function. (3) rebuild spinal stability, reduce bedtime and improve patient’s health condition[2].Over the years has been that for the best therapy for spinal metastasis is to remove the tumor completely[3].Although the complete removal of the tumor is very difficult, with the improvement of microsurgical technique internal fixation materials, minimally invasive techniques have shown a huge advantage on excision of cervical vertebra tumor.PengHe et al[4], summarizes several application of minimally invasive techniques in the treatment of spinal metastatic tumor surgery.As time passes on, the minimally invasive technique will play a more important role of in the treatment of the atlantoaxial metastatic tumor.
According to this case , because the whole vertebral axis has been destroyed, we must use anterior fixation in order to maintain the stability of the cervical spine, and reconcile the bone graft fusion, C3 centrum and odontoid. We first apply titanium cable and hollow screws from the back to stabilize the posterior column. Then we remove the tumor through the patient’s oral, iliac bone implantation does not use titanium plate, so as to reduce the stage of body rejection and the risk of infection. During this period, we use percutaneous cannulated hollow screw fixation to effectively stabilize the odontoid and iliac bones. The two surgical resection combining perfectly and providing strong atlantoaxial stability, is an effective method for the treatment of atlantoaxial vertebral tumors, and is worth promoting. After bone scanning, it appears that the patient doesn’t have any other metastasis except for the tumor which spread from the kidney to the epistropheus centrum. After the surgery, the patient will wear a collar to care for himself, which can help improve his health condition. Plus, the patient is young and strong, if he actively cooperates with other methods to treat this primary disease, the patient may even have the opportunity to live for a longer time.
[1]Masala S, Guglielmi G, Petrella MC, et al. Percutaneous ablative treatment of metastatic bone tumours: visual analogue scale scores in a short-term series [J]. Singapore Med J, 2011, 52(3): 182-189.
[2]GuiXun Shi,MingSheng Tan.Surgical treatment of metastatic tumors of the spine. Chin J Tumor & Bone Disease,August 2010,Vol 9,No.4:360-363.
[3]Ecker RD,Endot,Wetjen NM,st al.Diagnosis and treatment of Vertebral column metastases[J].Mayo Clin Proc,2005,80(9):1177-11
[4]PengHe,Yuzhang,Qingshui Yin.Application of minimally invasive technique in the treatment of metastatic tumors of the spine.Journal of Practical Orthopaedics Vol.21,No.2,Feb.2015:136-140.