C2 spinal tumor removed from whole block with oral robot surgery combined with ultrasound bone knife

Chordoma is a rare type of invasive tumor derived from the residual tissue of the spinal cable embryo, which is good at slopes and tibia; Spinal stoma is low-grade and slow-growing, but it is invasive and destructive to the surrounding structure, and incomplete excision increases the recurrence rateTherefore, surgical treatment tends to remove the whole tumor and assist radiotherapy in order to get the best resultsTraditional surgery is difficult to achieve the whole piece removal, and the trauma is largeTransoral robotic surgery (transoral robotic surgery, TORS) has been successfully used to remove lesions involving the structure of the mouth and pharynxUltrasonic bone knife is small in size, low thermal conductivity, and does not damage soft tissueDmitriy Petrov, of the University of Pennsylvania's Perelman School of Medicine, and others reported one case using TORS technology combined with an ultrasound bone knife to remove cervical spinal spinal protoma;method of studymale, 27-year-old patientAs a result of the traffic accident, the ct scan of the cervical vertebrae accidentally found a 2.2 cm diameter lesions on the back of the C2 vertebraeMrI examination suggested that the lesions caused damage to the C2 vertebral body and violated the tooth protrusions without invasive of the epidural, and the pathological results of the puncture biopsy in the outer hospital were in line with the pathological characteristics of spinal ism (Figure 1)After admission to the hospital by neurosurgery, otolaryngology, oncology and radiotherapy MDT discussion, determined to first use cervical vertebral after-road removal C1-3 vertebral plate and part of the vertebral body, and then by oral robot surgery combined with ultrasound bone knife whole excision lesions, postoperative auxiliary radiotherapyFigure 1Preoperative imaging examinationACervical CT axonss scan showed C2 bone-dissolved lesions, which violated the vertebral tubesBCervical MRI-T1 weighted axial enhancement imaging showed uneven reinforcement of lesions in the back of the C2 vertebrae C.MRI-T2 weighted target imaging showed a spinal prosthesis in the back of the C2 vertebral body, with no epidural aggression D Navigation guided tumor biopsy surgery is carried out in two steps The first stage is C1-3 vertebral plate and partial vertebral incision (Figure 2) The second stage was performed by the otolaryngologist using TORS technology to remove C2 spinal tumor sylloma using tors technology cervical vertebral front road combined with sonopet ultrasound bone knife (Figure 3) Finally, cervical fusion Figure 2 A Ct after Stage 1 surgery shows vertebral plate and partial vertebral excision B The photo from stage 2 shows the back of the spinal cord after the c2 vertebral plate is removed C The upper part of the C2 vertebrae and C2 were exposed using TORS technology, and the front view of the C2 vertebrae and dental protrusions was not removed D C2 photo after the removal of the spinal implant block, implanted screws on the C1 and C3 side blocks and one screw at the C2 gorge Figure 3 A diagram of cervical pre-operative surgery using TORS technology A C2 spinal tumor (top right) was removed using a Sonopet ultrasound bone knife, and a fusion of the pillow bone to C2 (bottom right) the results of the study
postoperative imaging showed a complete excision of the lesions, and the pathology examination was diagnosed as spinal stoma After surgery, the patient developed an infection of the wound oral flora, and the wound was detected and recovered after 10 weeks with antibiotics 7 months after the operation, the patient resumed work Mr MRI was reviewed 15 months after the operation and no obvious lesions were found The case was used by oral robot surgery combined with Sonopet ultrasound bone knife to remove cervical spinal spinal stoma, to minimize the risk of tumor recurrence after surgery, and to avoid postoperative radiotherapy, it is worth applying to the treatment of spinal stoma in this area.