Abstract：
BACKGROUND: Pathological destruction of the axis vertebra leads to a highly unstable condition in an upper cervical spine. As surgical resection and anatomical reconstruction of the second cervical vertebrae represents a life threatening procedure, less radical approaches are preferred and only few cases of C2 prosthesis are described in literature.
METHODS: The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed CONCLUSION: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection.
METHODS: The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed CONCLUSION: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection.
摘要：
背景：中轴椎骨的病理性破坏导致上颈椎的高度不稳定状况。由于第二颈椎的手术切除和解剖重建代表着危及生命的过程，较少彻底的方法是优选的，只有少数C2假体病例在文献中描述。
方法：本病例报告的重点是一名21岁的男性，其C2病理性骨折主要通过手术治疗C1-C3背侧融合术。由于巨细胞瘤的进展和轴椎骨的破坏，通过前入路和背侧枕颈融合C0-C4进行C2假体。术后感染采用2期背侧清创手术治疗，骨合成材料改变和自体骨移植。头孢曲松联合阿莫西林/克拉维酸进行4周静脉治疗后，随后每次口服阿莫西林/克拉维酸联合环丙沙星治疗12周，感染完全恢复。在最后一次翻修手术后2个月开始放射治疗，患者在1年的随访中显示出良好的临床结果，结构稳定。对所有报道的C2假体病例的文献进行了回顾。结论：C2假体允许在涉及轴椎骨的病理过程中进行更彻底的切除。结合后路融合，立即实现稳定。前路手术方法是通过高度无菌的口腔环境进行的，这存在术后感染的高风险。
方法：本病例报告的重点是一名21岁的男性，其C2病理性骨折主要通过手术治疗C1-C3背侧融合术。由于巨细胞瘤的进展和轴椎骨的破坏，通过前入路和背侧枕颈融合C0-C4进行C2假体。术后感染采用2期背侧清创手术治疗，骨合成材料改变和自体骨移植。头孢曲松联合阿莫西林/克拉维酸进行4周静脉治疗后，随后每次口服阿莫西林/克拉维酸联合环丙沙星治疗12周，感染完全恢复。在最后一次翻修手术后2个月开始放射治疗，患者在1年的随访中显示出良好的临床结果，结构稳定。对所有报道的C2假体病例的文献进行了回顾。结论：C2假体允许在涉及轴椎骨的病理过程中进行更彻底的切除。结合后路融合，立即实现稳定。前路手术方法是通过高度无菌的口腔环境进行的，这存在术后感染的高风险。
