Surgical management of posterior mediastinal tumors with intraspinal extention

In this study, ten patients with posterior mediastinal tumors were subjected to thorough clinical and radiological examination including CT and MRI chest and thoracic spine to determine the site of the tumor and the extent of invasion of the thoracic vertebral bodies and/or their neural arches. Preoperative CT guided biopsy was done for all cases to identify the tumor pathology. The patients were followed up for a period ranging from 7 to 24 months for local or distant recurrence, spinal stability, neurological functions and the need for adjuvant therapy. Anterior approach [posterolateral thoracotomy] was done in seven patients, posterior approach was done in one case and combined anterior and posterior approaches were done in two cases. Total corpectomy alone was done in seven cases. Combined corpectomy and laminectomy were done in two cases and laminectomy alone in one case. In nine cases, dorsal spine was fixed anteriorly by instrumentation [Z-plate and screws] and iliac crest bone graft [eight cases] or isobone [one case]. In one case, fixation was done by posterolateral plates and screws and intertransverse bony fusion. All cases of fixation showed sound bony fusion. Nine cases were improved neurologically and only one case did not improve postoperatively

Primary extradural cervical tumors: Surgical experience and outcome of eighteen cases

The objective of this study was to clarify the most appropriate treatment and outcome of primary extradural cervical tumors. Eighteen patients with primary neoplasms of the cervical spine underwent radiographic, clinical evaluation and follow up evaluation. The patients were classified as having benign or malignant tumors. The surgical approach was individualized for each patient according to the site and type of the tumors. Transoral decompression followed by posterior fusion was performed in four cases, corpectomy and fusion in four cases, corpectomy and fusion followed by posterior decompression in two cases, both anterior and posterior decompression and fixation in three cases as well as posterior laminectomy and unilateral facetectomy without fusion in five cases. A preoperative embolization with polyvinyl alcohol was performed in ten cases. Postoperative radiation was used in eight cases. The study concluded that the primary tumors of the cervical spine should be considered in the diagnosis of patients with persistent neck pain. When confirmed, they should be defined carefully by appropriate radiological modalities to determine the proper surgical plane. The aim of the treatment should be a complete excision of the tumor [at least as much as possible], maintenance of spinal stability and preservation or restoration of the normal neurological function