Jia Lianshun

Giant Cell Tumor of the Cervical Spine : A Series of 22 Cases and Outcomes

Study Design. A consecutive series of 22 giant cell tumor (GCTs) of the cervical spine which underwent surgical treatment was observed from 1990–2003. Objective. This study reviews the clinical patterns and follow-up data of (GCT) of bone arising in the cervical spine which underwent surgical treatment. We attempt to correlate treatment and outcomes over time. Summary of Background Data. GCTs of bone are common, aggressive, or low-grade malignant tumors that occur infrequently in the spine above the sacrum, and their presence in the cervical vertebrae is even more exceptional. Though surgical resection of GCT arising in the cervical spine is commonly regarded as a recommended treatment method, it is still a challenge to achieve satisfactory results, especially for the late or recurrent cases, and there are few large series of cases reported with long-term follow-up of this tumor that are found in special segments in the literature. Methods. All clinical and follow-up data of 22 cases of GCT arising in cervical spine which received surgical treatment in our spine center from January 1990–December 2003 were collected. The choice of surgical intervention was based on the Weinstein-Boriani-Biagini grading system. Two meanly different protocols of surgical treatment were applied: 8 patients underwent subtotal resection (one of them died shortly after surgery and could not be followed up), 13 cases received total spondylectomy. One special lesion located in the posterior element of C7 received “en bloc” resection. For reconstructing the stability of the cervical spine, we used autologous ilium for pure bone graft, or titanium plate and titanium mesh for anterior instrumented fusion or anterior and posterior combined instrumented fusion. Postoperative radiation therapy was given in 18 cases as an adjunctive therapy method. Results. One patient with C1–C2 GCT (vertebral body and posterior element involvement) who received subtotal resection of the tumor showed aggravation of neurologic deficit and died shortly after the surgery. So we had 21 cases for mid and long-term follow-up, with an average of 67.8 months, that ranged from 36 to 124 months. The symptom of radicular pain almost disappeared, and patients suffering from spinal cord compression recovered well with at least 1 or 2 levels based on Frankel gradingsystem when re-evaluated at 3 months after operation. The rate of fusion for the bone graft is 100%. All the internal fixations were well fused and no spine instability could be seen in our series. Local recurrence was detected in 5 of 7 cases (71.4%) that underwent subtotal resection, but in only 1 of the 13 cases (7.7%) for total spondylectomy. Four cases died within follow-up and all these patients were recurrent cases. One patient developed pulmonary metastases. Conclusion. GCT of the cervical spine easily onsets between 20 and 40 years of age. As a kind of benign but local aggressive or low potential malignancy tumor, we should take an aggressive attitude to excise the tumor as much as possible while reserving the neural function as a precondition. Unlike in the thoracic and lumbar spine, a strictly “en bloc” resection is often not a feasible option because of the involvement of critical neurovascular structures. Total spondylectomy (even intralesional) with radiation therapy as an adjunctive treatment has significantly lowered the local recurrence rate of the GCT in the special segments.

Clinical significance of cervical vertebral flexion and extension spatial alignment changes.

Study Design. Radiographic review. Objective. To study changes in alignment and curvature of the cervical vertebral column in the sagittal plane, and to provide references for the orthopedic treatment of cervical kyphosis. Summary and Background Data. There are few reports analyzing changes of the vertebral body itself or changes in their relationships between separate vertebrae. To understand cervical vertebrae and curvature dynamic variation patterns in the sagittal plane and provide a theoretical reference for orthopedic correction of cervical kyphosis, we measured spatial position and alignment of the cervical vertebrae on sagittal plane films of various postures. Method. Blind repeated measures design analysis of sagittal view standard lateral, hyper flexion, and hyper extension cervical spine of 60 healthy subjects measuring spatial alignment angle of C2 to C7 vertebral bodies in the sagittal plain (∠A), C2 to C7 inferior terminal lamina tilt angle of (∠B), and segmental intervertebral space angles C2/3 to C6/7 (∠C) calculating flexion and extension amplitude changes in ∠A, ∠B, and ∠C. Cervical curve apex was determined using Borden’s method to compare change and distribution characteristics. Results. Segmental ∠A is a positive mean value that increases from C2 to C7 when in the upright position. In hyper extension, mean ∠A value decreases with gradual amplitude decrease from C2 to C7; however, a gradual overall increasing pattern is observed for mean ∠A from C2 to C7. In hyper flexion, segmental ∠A mean value increases with gradual amplitude decrease from C2 to C7, whereas with decreasing angular measurements from C2 to C7. ∠B follows similar change regularities as ∠A with a larger mean value than ∠A. During maximum extension and maximum flexion, ∠D is equal to ∠E. For example: C2 ∠D = C2 variable ∠A; C2 ∠E∠(C3 variable ∠A + C2/3 variable ∠C); and C2 ∠D = C2 ∠E. Cervical spine curve apex is mainly distributed between C4 and C5 on standard, hyper extension and hyper flexion lateral view. Conclusion. Dynamic cervical curvature changes based on a central apex, stems from vertebral rotation and displacement in the sagittal plane. Our study revealsvariation patterns of dynamic cervical spine sagittal alignment and curvature, providing vertebral spatial alignment value as reference for orthopedic cervical kyphosis corrective surgery.

Construction of metastatic spinal cancer tissue microarrays

Abstract Objective To explore the construction of metastatic spinal cancer (MSC) tissue microarrays and validate its value in immunohistochemical study of MSC. Methods Paraffin-embedded specimens from 71 MSC cases and 6 primary tumor cases were selected as donor blocks and prepared into MSC tissue microarrays by tissue array arrangement, the steps of which included location, punching, sampling, sample seeding, and re-diagnosis by hematoxylin-eosin (HE) as well as MMP-9 and MMP-14 immunohistochemical staining. Results The MSC tissue microarrays thus constructed were intact and crackless, containing 154 complete and well arranged microarray points. None of the sectioned tissue microarrays was lost, and the results of HE staining was consistent with the primary pathologic diagnoses. Immunohistochemical staining was also good without non-specific or marginal effect. Conclusion The MSC tissue microarrays have a high value in the immunohistochemical study of MSC.

Syringomyelia after operation: diagnosis and its formational mechanism

Abstract Objective To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years (range 2–10 months) by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid (CSF). The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.