PMC9614060_01
Anteroposterior and lateral radiographs of the cervical spine: (A) Osteolytic expansive lesion on C7 vertebral body, with ill-defined borders, expansion and interruption of the upper and lower endplate of the left half of the vertebral body and absent spinous process and left pedicle; also, abnormal cervical alignment in the frontal plane with a slight left-sided tilt of the neck is noted. (B) Enlargement of the posterior elements and upper endplate of C7 vertebral body, thinning of the cortical bone, without apparent interruption, periosteal reaction, or soft tissue mass.
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F1
Simple anteroposterior and lateral radiographs of the cervical spine were taken on the initial visit (Figure 1).
(A-C) Sagittal and axial MRI cuts of the cervical spine showing a multiloculated bone lesion in C7 that conditioned vertebral body collapse and subluxation, associated large soft tissue component, with intradural and paravertebral extension, without myelopathy signs. Partial destruction of left posterior elements of C6 and T1 is also visible. (D,E) Cervical spine CT revealing a destructive collapsing lesion in C7 vertebra, affecting the posterior part of the vertebral body and the posterior elements, and causing subluxation and angular kyphosis of the cervical spine. There was also partial involvement of the left pedicle, lamina, and spinous process of C6 and, to a lesser extent, the T1 left pedicle.
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F2
The spinal canal was markedly narrowed at C6-C7, partly due to altered alignment and partly due to invasion by the tumor, obliterating the left posterolateral subarachnoid space (Figure 2).
(A,B,C) post neoadjuvant chemotherapy MRI showing delimitation and minor shrink of the soft tumor mass. (D,E). MR myelography demonstrating significant compromise of the spinal canal, especially at C7 level.
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F3
Also, spinal canal compromise (Figure 3) was evidenced on MR myelography that manifested clinically with increased left radiculopathy.
Intraoperative images: (A-E). Anterior approach: (A) Exposure of anterior part of C6-C7 vertebral bodies; (B) Tumoral mass within vertebral bodies; (C) Preparation of Moss mesh with iliac crest allograft; (D) Placement of mesh with allograft in the cervical spine defect; (E) Anterior plate fixation. (F-J). Posterior approach: (F) Exposure of posterior vertebral elements; (G) Posterior vertebral arch resection for total piecemeal spondylectomy; (H) Spinal cord and roots decompressed; (I) Posterior instrumentation fusion C5-T3 with bilateral screws and rods; (J) Posterior part of the tumoral piece.
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F4
Consecutively, surgical resection of the tumoral mass and reconstruction (Figure 4) was performed at week 15.
Resected tumor histology of the patient. (A) Plexiform and fibrous bone tissue infiltrated by solid neoplastic proliferation (HE, 40x). (B) Tumor cells with fusiform and epithelioid morphology with marked cellular atypia and numerous mitotic figures (HE, 400x). (B,C) Malignant cells are surrounded by fibrovascular stroma and subtle osteoid deposits (HE, 400x, 200x). (D,E) Numerous osteoclastic multinucleated giant cells are identified (HE, 100x, 200x). (F,G). Expression of the Ki-67 proliferation marker.
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F5
The histopathological results mentioned that the surgical resection piece consisted of a bony tissue measuring 7 x 3.5 x 2.5 cm covered by muscular tissue (Figure 5).
Anteroposterior (A) and lateral (B) x-rays of the cervical spine at 3 years postoperatively: interbody moss mesh, anterior plate fixation, and bilateral posterior instrumentation fusion with screws and rods from C5 to T3. Adequate alignment and balance, without signs of implant loosening or lack of consolidation.
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F6
The last radiological examination can be seen in Figure 6.