Surgical resection of intradural extramedullary tumors in the atlantoaxial spine via a posterior approach

BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary (IDEM) tumors. Studies concerning surgical interventions via a posterior approach are limited. AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach. METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018. The analyzed data included tumor position, histopathological type, pre- and post-operative Japanese Orthopedic Association (JOA) scores and Nurick grades, postoperative complication and recurrence status. RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study. In all cases reviewed, total tumor resection and concomitant C1-C2 fusion were achieved. The average follow-up was 35.3 +/- 6.9 mo (range, 26-49 mo). A statistically significant difference was noted between the preoperative JOA score (11.2 +/- 1.1) and the score at the last final follow-up (15.6 +/- 1.0) (P < 0.05). A statistically significant difference was noted between the preoperative Nurick grade (2.3 +/- 0.9) and that at the last follow-up (1.2 +/- 0.4) (P < 0.05). However, no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle (P > 0.05). No mortalities, severe complications or tumor recurrence were observed during the follow-up period. CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach. Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.