PMC8492436_01
PMC8492436_02
(a) Computerized axial tomography showing pathological fracture at D1 and D2 vertebrae. (b) T2 sequence with fat suppression of magnetic resonance imaging of the cervicothoracic spine showing neoplastic infiltration into D1 and D2 vertebrae, associated to epidural component generating spinal cord compression.
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F1
The thoracic magnetic resonance imaging (MRI) showed a D1/D2 pathological compression fracture with anterior epidural extension of tumor compressing the cord [Figure 1b and 1c]. The computed tomography (CT) confirmed the pathological fracture of D1 [Figure 1a] (i.e. lytic and blastic characteristics) and further documented a 75% loss of height with retropulsion of the posterior wall of the vertebra into the spinal canal; at D2 level, there was blastic neoplastic infiltration involving the vertebral body, but no accompanying vertebral collapse.
PMC8492436_03
(a) Anterior cervical approach with median manubriotomy showing the anterior fixation plate already in place. (b) Posterior cervicothoracic approach showing the laminectomy area at D1 and D2 vertebrae and the cervicothoracic instrumentation from C4 to T6 vertebrae.
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F2
This was followed by placement of an autologous tricortical iliac crest bone graft from the C7 to D3 levels with anterior plate fixation [Figure 2a]. Cervical lateral mass screws were placed from C4 to C6 and pedicle screws from D3 to D6 [Figure 2b].
(a) Final postoperative tomography control showing the corpectomy area at D1 and D2 vertebrae, the 360  cervicothoracic fixation, and the osteosynthesis plate on the sternum manubrium. (b) Postoperative magnetic resonance imaging of T1 and (c) T2 sequences showing adequate spinal decompression and no signs of neoplastic recurrence.
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F3
Six months later, X-rays confirmed that the construct had remained intact, while the MRI showed adequate cord decompression without signs of local tumor recurrence [Figure 3b and c].
PMC8492436_04
(a) Final postoperative tomography control showing the corpectomy area at D1 and D2 vertebrae, the 360  cervicothoracic fixation, and the osteosynthesis plate on the sternum manubrium. (b) Postoperative magnetic resonance imaging of T1 and (c) T2 sequences showing adequate spinal decompression and no signs of neoplastic recurrence.
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F3
Six months later, X-rays confirmed that the construct had remained intact, while the MRI showed adequate cord decompression without signs of local tumor recurrence [Figure 3b and c].