Transoral Resection and Reconstruction for Primary Osteogenic Sarcoma of the Second Cervical Vertebra

Abstract

STUDY DESIGN: A case of primary osteogenic sarcoma at the second cervical vertebra is reported. OBJECTIVES: To document an osteogenic sarcoma of the second cervical vertebra and its treatment, and to review the literature. SUMMARY OF BACKGROUND DATA: Primary osteosarcoma of the cervical spine is encountered infrequently, and its location in the upper cervical spine is extremely rare. Two cases of osteosarcoma in the second cervical vertebra have been reported previously in the literature. METHODS: A 15-year-old boy with a mass lesion in the axis was treated surgically by anterior transoral resection, fusion, and reconstruction of the defect with a Harms cage. The resection was completed by posterior excision of the remaining vertebral elements, and by occipitocervical instrumentation and fusion between the occiput and the fourth cervical vertebra. The therapy was completed by adjuvant chemotherapy and radiotherapy. RESULTS: At this writing, 40 months after the initial diagnosis, the patient was in a good state of health with his underlying disease. CONCLUSIONS: The axis is a very rare location for the occurrence of primary osteosarcoma. Osteosarcoma may histologically mimic chondroblastoma. The axis can be surgically exposed, resected, and instrumented transorally. The stabilization must be augmented by posterior occipitocervical fusion.