Implant Reconstruction of the Mobile Spine

Abstract

En bloc spondylectomy maximizes the likelihood of cure in patients with localized primary malignancies of the spinal axis. Numerous critical structures around the spine must be taken into consideration and carefully controlled or sacrificed in these complex, often multi-disciplinary and multi-stage endeavors. After en bloc spondylectomy, the spinal column is rendered unstable and must be reconstructed to allow patients to mobilize safely without compromising the neural elements. Pedicle screw and rod constructs represent the workhorse of modern spinal reconstruction technique with intervertebral body cages allowing facile reconstruction of the anterior column. These implants confer crucial initial stability to the spine while bony fusion takes place. En bloc spondylectomy and subsequent reconstruction of the cervical spine present a number of unique challenges compared to the rest of the mobile spine given the local anatomy including the airway, esophagus, vertebral arteries, cervical nerves, and the functional deficit from sacrifice of cervical nerve roots. We present the case of a synovial sarcoma involving the lower cervical spine with vertebral artery encasement that was managed with en bloc spondylectomy and reconstruction using posterior rod and screw fixation and an anterior expandable titanium cage.