A novel fixation technique using anterior C1 screw in a pediatric solitary cervical spinal juvenile xanthogranuloma

European spine journal

article

Rekhapalli Rajasekhar¹  Madhivanan Karthigeyan¹  Pravin Salunke¹  Kirti Gupta² 

[1] Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER);Department of Histopathology

关键词: Juvenile xanthogranuloma;    Non-Langerhans cell histiocytosis;    Craniovertebral junction;    Cervical spine;    Fibular graft;    Vertebral body;    C1 screw;   

DOI  :  10.1007/s00586-019-05915-4

来源: Springer

【 摘 要 】

Juvenile xanthogranuloma (JXG) presenting as solitary vertebral body lesion is infrequently seen and usually limited to one or two levels. We report a case of an isolated JXG with extensive cervical spinal (bony and extradural) involvement in a 6-year-old child. There was a diagnostic dilemma as the radiologic and intraoperative picture resembled tuberculosis. The spinal reconstruction was also challenging due to involvement of multiple vertebral levels and necessitated an anterior C1 screw. The lytic lesion was multicompartmental, involving the craniovertebral junction and the subaxial spine (till C6 vertebral body) and extending into the retropharyngeal space. Noticeably, an associated thoracic syringomyelia was also present. Near-total excision of the lesion and 360° spinal fixation was performed using fibular strut graft. The graft was cranially anchored to the C1 anterior arch, thereby sharing the load with the posterior occipito-cervical instrumentation in order to avoid a construct failure due to cantilever effect. At 12-month follow-up, the patient had good clinico-radiologic outcome with evidence of bony fusion and resolution of syrinx. The report highlights the diagnostic dilemma of JXG lesion on both the radiology and surgery and discusses the challenges in the management and the relevant literature. The described technique can be a viable option in pediatric tumors with extensive C2 vertebral body involvement. Occasionally, extradural compression can have associated syrinx formation and the primary treatment per se could tackle the underlying syringomyelia.

【 授权许可】

Unknown