OBJECTIVE: To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy.
METHODS: A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5 cm mass within the spinal canal at the C4-6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4-5 and C5-6 facet joints.
RESULTS: After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3 months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4-5 and C5-6 intervertebral foramen 2 years postoperatively.
CONCLUSIONS: Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.

The spine is the most common site of bone metastases. Many cancer patients will ultimately develop spinal metastatic disease with symptomatic epidural spinal cord compression. At present, the main treatment for cervical spine tumors is surgical resection combined with postoperative radiotherapy. Implant materials for cervical spine anterior column reconstruction need to meet amounts of different properties, such as biocompatibility, bioactivity and the ability to maintain long-term mechanical strength. The selection of different materials determines the surgical efficacy and prognosis of patients to a certain extent. This article provides an overview of a variety of implant materials used for anterior column reconstruction after cervical spine tumor resection, introduces and analyzes their properties, advantages, disadvantages, derivatives, and applications in clinical practice, and looks forward to the future development of implant materials.

Intradural extramedullary metastatic melanoma is a rare entity with only 13 other cases reported in the literature.1 Of these, only 3 have been described in the cervical spine.2-4 Metastatic melanoma to the brain has historically portended a grim prognosis; however, due to the paucity of reported intradural lesions, the clinical course, including surgical findings, is less well known. This video illustrates a case of a 59-year-old man with new left arm pain and numbness found to have cervical intradural extramedullary metastatic melanoma (Video 1). This video also demonstrates surgical principles and techniques for removal of a rare cervical intradural extramedullary melanoma metastasis using standard cervical laminectomy with intraoperative ultrasound for tumor localization. Considering its rarity, visualizing the intraoperative resection is important for surgeons who may potentially treat such pathology. Patient consented for the procedures and for publication of the video.

This video demonstrates the microsurgical removal of an intramedullary spinal cord hemangioblastoma through an anterior cervical approach. While most spinal hemangioblastomas arise from the dorsal or dorsolateral pial surface and can be safely resected through a posterior approach,1,2 ventral tumors can present a significant challenge to safe surgical removal.3-5 This patient presented with a progressively symptomatic ventral pial based hemangioblastoma at the C5-6 level with large polar cysts extending from C3 to T1. The tumor was approached through a standard anterior cervical exposure with a C5 and C6 corpectomy. Following midline durotomy, the tumor was identified and complete microsurgical resection was achieved. The principles and techniques of tumor resection are illustrated and described in the video. Following tumor resection and dural closure, a fibular allograft was inserted into the corpectomy defect and a C4-C7 fixation plate was placed. The patient was maintained in a supine position for 36 h. He was discharged home on postoperative day 3 in a cervical collar. The patient did well with near-complete recovery of neurological function. Postoperative magnetic resonance imaging at 6 wk showed a substantial resolution of the polar cysts and no evidence of residual tumor. The patient featured in this video consented to the procedure.

Chordomas are rare, locally aggressive neoplasms that develop from remnants of the notochord. The typical approach to chordomas of the clivus and axial cervical spine often limits successful en bloc resection. In this case report, authors describe the first-documented transoral approach using both transoral robotic surgery (TORS) for exposure and the Sonopet bone scalpel under navigational guidance to achieve en bloc resection of a cervical chordoma. This 27-year-old man had no significant past medical history (Charlson Comorbidity Index 0). During a trauma workup following a motor vehicle collision, a CT of the patient\'s cervical spine demonstrated an incidental 2.2-cm lesion situated along the posterior aspect of the C2 vertebral body. Postoperative imaging showed successful en bloc resection with adequate placement of hardware, and the pathology report demonstrated negative resection margins. The patient tolerated the procedure well, and because of the successful en bloc resection, radiation has been deferred. At 7 months postoperatively, the patient returned to work in New York City. Contrasted MRI at 15 months postoperatively showed the patient to be disease free. This approach offers a promising way forward in the treatment of these complex tumors.

This operative video demonstrates a posterior cervical laminoplasty for the resection of a cervical intradural extramedullary meningioma. In addition, the natural history, treatment options, and potential complications are discussed. The patient is a 68-yr-old male who presented with left-hand grip weakness and paresthesias. Magnetic resonance imaging (MRI) demonstrated an enhancing mass that displacing the spinal cord anteriorly and causing severe flattening of the cord at C4 and C5. The patient underwent a posterior cervical laminoplasty for tumor resection. Removal of the dorsal elements with a high-speed drill was performed at C3, C4, and C5. A midline durotomy was performed and a large extra-axial intradural tumor was encountered. The tumor was resected en bloc and specimens were sent for permanent pathological analysis. The dura was closed in a watertight fashion using 6-0 Prolene sutures. The laminoplasty was performed by using titanium miniplates and screws to reconstruct the dorsal bony elements, and the wound was closed in layers using sutures. There were no complications. Final pathology was consistent with a WHO grade I meningioma. Postoperative MRI demonstrated gross total resection. The patient\'s perioperative course was uncomplicated and his preoperative weakness completely resolved by time of discharge.

BACKGROUND: Chordomas are locally aggressive tumors that can involve multiple levels of the spine and are difficult to resect. We present our technique for 4-level en bloc cervical spondylectomy for a locally aggressive chordoma.
METHODS: A 37-year-old woman presented with a 6-month history of dysphagia and a large indurated cervical mass. Imaging showed an enhancing lesion involving C3-6. Needle biopsy confirmed the diagnosis of chordoma. En bloc resection was chosen to maximize her chances of disease-free survival. A 360° approach was deemed necessary. We posteriorly disconnected the vertebral bodies and skeletonized the bilateral vertebral arteries and nerve roots. The interspinous and yellow ligaments and the spinous processes were spared to maintain a solid posterior tension band, as previously described approaches that had sacrificed these elements had a high rate of instrumentation failure. After posterior instrumentation, a wide anterior approach enabled us to resect the tumor attached to the vertebral bodies of C3-6 as 1 specimen. A 4-level corpectomy cage and plate were used for anterior instrumentation. The patient tolerated the surgery well. She needed a temporary gastrostomy, and she had a right C5 palsy that progressively recovered. Follow-up imaging showed no tumor recurrence and good bony fusion.
CONCLUSIONS: En bloc resection as part of a multidisciplinary team approach remains the mainstay of spinal chordoma treatment. Modern instrumentation and careful dissection can provide good results even in locally advanced cases.

Aneurysmal bone cysts (ABC) form 1 % of primary bone tumors. Reported incidence rates are no more than 1.4 to 1,00,000. ABC of spine frequently involves posterior elements and commonly affects the lumbar spine (45 %). We present a case of C2 ABC for the challenges it poses due to the rarity of the lesion, tedious to access location, dilemmas relating to the suitable approach for tumor resection and technically demanding stabilization and reconstruction strategy post resection.
Clinical data analysis was performed to discuss a method of novel anterior column reconstruction following resection of a C2 aneurysmal bone cyst in a 8 year old child with anterior and posterior elements being involved.
An 8-year-old girl with an aneurysmal bone cyst of the C2 vertebra underwent staged surgery following pre-operative embolisation. First a posterior approach tumor excision with posterior instrumented fusion was performed. Following which, using a modified anterior retropharyngeal approach anterior tumor excision and fibular graft reconstruction between the C1 lateral mass and C2 body was performed. Complete tumor clearance and stable reconstruction was successfully achieved in our patient. Patient showed excellent clinical outcome with radiological fusion.
Preoperative embolisation in the treatment of ABC has supplemental advantage by reducing blood loss. Modified anterior retropharyngeal approach allows satisfactory clearance for C1-2 lesion and fibular strut graft between the C1 lateral mass and C2 body can provide a stable graft placement with good chance of fusion. Instability and spinal deformity, whether preexisting or post-excision, should be corrected with reconstruction and stabilization to offer best chance of cure in such cases.

We present a case of C6 mesenchymal chondrosarcoma and discuss safe posterior to anterior approach subtotal en-bloc spondylectomy.
A 29-year-old male consulted for our department with severe posterior neck pain doing exercise. CT scan demonstrated a primary osteolytic lesion on C6 left transverse foramen and MRI demonstrated the tumor involved C6 vertebra from layers B, C and F sectors 4-6 encasing left vertebral artery. Preoperatively neurointerventional radiology service occluded the left vertebral artery and tumor feeding artery using coil embolization. Posterior approach consist of C5-C7 laminectomy, left sided C6 and C7 nerve root sacrifice, posterior disc removal and release of C5-6-7 and posterior reconstruction. Then, position was changed to supine, and the anterior approach was followed as C5-6, C6-7 discectomy, left vertebral artery ligation and cut, longus coli resection and C6 subtotal spondylectomy with en-bloc resection of mass, mesh cage insertion and C5-C7 anterior plate fixation. During operation, frozen biopsy was performed on 8 areas (longus coli, lateral margin, anteroinferior margin, posterior margin, posterosuperior margin, C5 transverse foramen, posteroinferior margin, inferior margin) after wide resection. Tumor free margin was confirmed.
After operation, he complained of tingling sensation of left thumb and forearm medial side, and elbow extensor motor grade was checked to 4/5 postoperatively. In the followed-up radiograph, the tumor was completely removed, and the instability of joint was not seen. As a result of observing follow-up CT at a year after the surgery, recurrence findings have not been shown up to now, and the progression of neurologic symptoms has not been shown either.
Based on the Grand Round case and relevant literature, we discuss the case of mesenchymal chondrosarcoma occurring from the C6 cervical spine treated with cervical subtotal en-bloc spondylectomy. Successful en-bloc resection of the tumor was achieved using posterior to anterior approach.