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A unique procedure of joined transoral and retropharyngeal high cervical approach (JTRC) without mandibulectomy for treating upper cervical neoplasm involving both C2 and C3

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Abstract

Purpose

To investigate a unique procedure of joined transoral and retropharyngeal high cervical approach (JTRC) without mandibulectomy for treating upper cervical neoplasm involving both C2 and C3.

Method

A 23-year-old male patient had neoplasma involving C2 and C3 that caused pathologic fracture of C2 and bony destruction of C3. The neoplasm excision and cervical spine reconstruction were performed through JTRC approach without splitting up the mandible. In this approach, there were two surgery windows that could be applied in turns by closing or opening the mouth to gain an ideal exposure. By rotating the mandible, we could gain maximized exposure for either surgery windows. In addition, there was an overlay zone between transoral approach and high cervical retropharyngeal approach that could eliminate the blind area behind the mandible.

Results

All the procedures were successfully performed; the surgical incisions healed without infection. By operating alternatively between the two surgery windows, we have successfully performed neoplasm excision and cervical spine reconstruction involving both C2 and C3. Pathologic results showed metastatic renal cell cancer to the resected cervical tumor and confirmed the patient’s diagnosis of tuberous sclerosis (Bourneville disease). A 3-month postoperative cervical spine radiography and CT scan demonstrated a favorable placement of the bone implant as well as a favorable instrumentation.

Conclusion

The JTRC approach could provide good surgical exposure for treating disorders involving both upper and lower cervical spine without splitting up the mandible.

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Authors and Affiliations

  1. Department of Orthopaedic, General Hospital of Military Army in Guangzhou Command (LiuHuaQiao Hospital of GuangZhou), Guangzhou, 510010, China

    Jianhua Wang, Hong Xia & Qingshui Yin

  2. Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL, 60612, USA

    Yang Lu

Authors
  1. Jianhua Wang
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  2. Yang Lu
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  3. Hong Xia
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  4. Qingshui Yin
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Corresponding author

Correspondence to Jianhua Wang.

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All the authors declare no conflict of interests.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No identifiable patient information was included in this case report. Informed consent was waived as per IRB policy on this retrospective case report. The manuscript has not been published before or is not under consideration for publication anywhere else and has been approved by all co-authors.

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Wang, J., Lu, Y., Xia, H. et al. A unique procedure of joined transoral and retropharyngeal high cervical approach (JTRC) without mandibulectomy for treating upper cervical neoplasm involving both C2 and C3. Eur Spine J 26, 1090–1095 (2017). https://doi.org/10.1007/s00586-016-4798-4

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  • DOI: https://doi.org/10.1007/s00586-016-4798-4

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