Surgical approaches for radical resection of cervical Spine lesions: analytical review and surgical experience with correlation to the vertebral artery. A retrospective study

The management cervical spine lesions, with spinal cord compression and vertebral artery involvement, are problematic both in terms of obtaining adequate resection and stabilisation and ensuring neurovascular compromise. Cervical spine approaches for total resection of the underlying pathology and reconstruction even in a staged operation are still a matter of challenge. Twelve patients with Non traumatic, non spondylotic cervical spine disorders were managed in this study. The cardinal presentation was neck and arm pain with progressive cervical myelopathy. All patients had plain x-rays of cervical spine, cervical spine CT scan MRI. The angiogram was performed to both vertebral arteries when the pathology is in proximity to the vertebral artery. When tumour blush with feeders was evident; endovascular embolisation to minimize intraoperative bleeding was also considered. A single approach or combined anterior and posterior cervical approaches for corpectomy and cage with plate fixation and then posterior fixation for gross total resection of the lesion was considered as indicated. All cases made a good neurological recovery and had no neural or vascular complication. Two patients had superficial wound infection that recovered well. Three patients died; two of them died of their primary malignancy and one died from pulmonary embolism. On the long term follow up, there was no recurrence of the disease or surgical failure of the instrumentation. This report documents a safe and reliable way to deal with non spondylotic, non traumatic cervical spine lesions with preservation of the vertebral arteries in a retrospective manner

Management of spinal cord cavernous haemangioma

Cavernous haemangioma [CH] is a vascular malformation described as sinusoidal vascular channels located within the neural tissue but lacking intervening neural elements. Although spinal cord is not a frequent site for these lesions, the spinal cord cavernous haemangioma is currently encountered more frequently with magnetic resonance imaging. Management of both symptomatic and asymptomatic intramedullary cavernous haemangioma is a matter of debate as these lesions may cause a devastating spinal cord dysfunction. We present a young patient with thoracic intramedullary cavernous haemangioma who first presented with two episodes of transient paraparesis before he had a major intramedullary bleeding that rendered him in paraparesis and incontinence. We emphasize to consider early surgical resection as soon as possible to prevent potentially irreversible spinal cord damage secondary to a large or recurrent small bleedings