Cervical Chondrosarcoma: Treatment and Outcome

In this case, a C1-C4 fusion after a posterior hemilaminectomy of C2 was performed because of the extensive involvement of the upper cervical spine. Occipitocervical fusion was not deemed necessary as there was no involvement of the C1 arch or occiput.

Through a posterior approach, stability was achieved first with left C2 pedicle screw and C1, C3, and C4 lateral mass screw insertion and instrumentation. To supplement the instrumentation, the Gallie wiring technique was utilized from C1-C3 with tricortical iliac crest bone graft. Next, resection of the right C2 lamina, lateral mass, and facet joint was performed first to reveal the C2 nerve root and vertebral artery. Both the C2 nerve root and vertebral artery were divided without entering the tumor mass. The anterior decompression was then addressed by a partial right anterior corpectomy of C2 with the insertion of a tricortical iliac crest allograft between C1-C3.

With the help of an otolaryngologist, an anterior approach was performed through a high submandibular incision connecting the proximal posterior incision transversely so that a skin flap exposed the sternocleidomastoid muscle and spinal accessory nerve. The sternocleidomastoid muscle was detached and the tumor mass dissected and mobilized with sufficient soft tissue margins. An osteotome and power burr was used to resect the C2 vertebral body with negative bony margins, and the entire tumor mass was removed in one piece. Because of press fit of the allograft, anterior instrumentation was not needed.

Figure 4 (below)is a postoperative radiograph demonstrating C1-C4 posterior instrumented fusion on the left-side supplemented with Gallie wiring. An anterior C2 hemicorpectomy with iliac crest allograft was also performed.

Figure 4

Postoperatively, the patient was intubated for two-days. Unfortunately, patient had difficulty swallowing temporarily and was unable to tolerate an oral diet. The patient failed a swallow study; therefore, tube feedings began through a nasogastric tube. The patient failed a second swallow study during hospitalization, so a gastric tube was placed for feeding. The patient was discharged from the hospital on postoperative day 21.

Outcome
At most recent follow-up, 10-months, the patient is alive and does not exhibit evidence, clinically or radiographically, of local recurrence of his chondrosarcoma. He does not endorse any neurological complaints and is now on an oral diet without the use of a gastric tube.

Cervical Chondrosarcoma: Case Commentary Vincent Traynelis, MD