Gross Total Resection of the Entire Cervical Spine Tumor: A Technical Note on Surgical Planning and Design of a Novel 3D-Printed Vertebral Prosthesis for Reconstruction from Skull Base to Thoracic Vertebra.

Abstract

Gross total resection (GTR) is a cornerstone in the treatment of various primary spinal tumors, including chordoma. However, achieving GTR for multisegment cervical tumors presents significant technical challenges due to the complex surrounding anatomy and the absence of standardized methodologies for anterior spinal column reconstruction. We describe the technical nuances of GTR and reconstruction for an 8-level (C1-T1) spinal chordoma in a 55-year-old female. The procedure was performed in 2 stages: a posterior approach for lamina and posterior element resection and neurovascular dissection, followed by an anterior approach for segmented tumor and vertebrectomy removal. In addition, we present an innovative design for a customized 3D-printed vertebral prosthesis aimed at facilitating multilevel cervical reconstruction. Perioperative complications, including respiratory muscle dysfunction, pulmonary infection, and cerebrospinal fluid leakage, were effectively addressed through a multidisciplinary approach. GTR was successfully achieved through a two-stage surgical procedure, which involved the reconstruction of the C1-T1 spine utilizing a posterior screw-rod system in conjunction with an anterior 3D-printed prosthesis between skull base and thoracic vertebra. By 3 months after surgery, neurological function was largely restored. During a 36-month follow-up period, there was no evidence of tumor recurrence or implant failure. This case of a recurrent C1-T1 chordoma illustrates that GTR for extensive, multisegment cervical tumors is achievable through meticulous surgical planning. 3D-printed prostheses provide an effective approach for anterior cervical reconstruction after multi-segment resection. Multidisciplinary perioperative care remains essential for managing such complex multisegment resections.