Case 67: neck pain and cervical body tumor

posted: January 21, 2003

Residents: Najeeb Thomas, MD and Alex Jones, MD
Faculty: Deepak Awasthi, MD

CLINICAL PRESENTATION: Clinical Presentation: This 55 year woman presented to the clinic with a history of unremitting neck pain for 6 months. The neck radiated into teh shoulders (right more than the left). No tingling, no shooting pain, no numbness, no weakness, no walking dificulties, no bowel/ bladder problems. Past medical history is significant for diabetes mellitus, hypertension, coronary artery disease (s/p angioplasty); patient is not a smoker or drinker. She is married with children.

EXAMINATION: Clinical examination reveals normal vital signs; decrease range of motion in the neck with posterior cervical tenderness (midline and to the right). No focal neurological deficits are noted.

DIAGNOSTIC STUDIES: The patient presented with a cervical MRI scan done elsewhere. Sample images are shown below:

Sagittal T1-weighted image on the left and axial image on the right (both done after contrast) showing a non-enhancing mass (red marker) in the C2 body (more to the right) extending into the spinal canal, sparing the C2-3 disc.

A cervical CT scan was ordered. Select views are shown below:

A coronal CT reconstruction on the left and an axial view on the right reveal a destructive process of the C2 vertebral body (black markers) on the right with sparing of the dens.

STEPS TAKEN AT LSUHSC: Given the difficult location of the tumor; biopsy ws considered, but refused by the patient. Preoperative differntial diagnosis included: chondroma, sarcoma, metastatic process, chordoma, chondrosarcoma, osteoma.

The patient was taken to the OR and initially had a posterior stabilization (occiput to C3) with pedicle screw in the left C2 pedicle; the right C2 pedicle was involved with tumor which was removed; lateral mass screws in C3 bilaterally and an occipital plate (see the intraoperative pict below)

Subsequently the patient ws turned supine and through a high cervical approach the C2 body tumor was approached and completely resected. The remainder of the body was replaced with a Harms cage filled with allograft and autologous growth factor. See the postop xrays and CT scans below;

Postoperatively, the patient has done very well. She is now home. The only deficit she has is a mild right hypoglossal paresis.

PATHOLOGY: Chordoma

Comments and Questions about this interesting case are welcomed. Please e-mail: dawast@lsuhsc.edu

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