Posterior Cervical Laminoplasty (Bioplate cranial fixation system) and Excision Of C5 nerve sheath tumour



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Spinal nerve sheath tumours (NST), also known as peripheral nerve tumours, are uncommon growths that develop in the covering (sheath) of nerves within the spinal canal or along peripheral nerves branching from the spine. These tumours can occur in different parts of the body but are particularly relevant when they affect the spine.

The two primary types of benign nerve sheath tumours are Schwannomas and neurofibromas. Malignant peripheral nerve sheath tumours are an aggressive and invasive cancer that develop in about 8-13% of patients with NF1. They can also occur sporadically and are associated with a poor prognosis.

Managing spinal nerve sheath tumors often requires a multidisciplinary approach involving neurosurgeons, oncologists, and other specialists to determine the best course of treatment for each individual case. Regular follow-ups are essential to monitor the tumor’s growth and manage any recurrent symptoms.

Indications for surgical treatment should be considered on a case by case basis.  There is no good literature on the proportion of cases that require surgical treatment.  However, in all cases the option of surgery should be considered and normally surveillance imaging is required if conservative management is pursued.

Apart from malignant transformation the indications for surgical treatment are in the main the development of a progressive radiculopathy, spinal cord extension and  rapid growth of the tumour.

Nerve sheath tumours in the cervical spine are most often approached from posteriorly as this allows easy visualisation of the critical neural structures and less risk to the vertebral artery.

There are several variations on the posterior approach, including formal laminectomies or laminoplasty, when the bone is replaced. The advantages of laminoplasty are thought to be restoration of spinal stability and lower risk of late progressive kyphosis. This is the approach described here.

There are a variety of laminoplasty implant options available on the market.  In this case simple  titanium mini plates are used to fashion a laminoplasty.

Bioplate fixation is with self-drilling screws and two hole straight plates, the screws and plates are made from titanium.  The screws are available in 1.9mm and 1.5mm lengths.

If there are concerns regarding spinal stability there is also the option to perform a posterior instrumented fusion. This was not deemed necessary in this case.

OrthOracle readers will also find the following associated instructional techniques of interest:

Cervical laminectomy and resection of spinal cord tumour

Cervical Laminoplasty for treatment of Cervical spondylotic myelopathy

Posterior Cervical Decompression and Fusion using DePuy Mountaineer Instrumentation

Cervical spine decompression: Posterior approach (Degenerative cervical myelopathy).

(With thanks to Navin Furtado FRCS whose case is demonstrated)

Author: Mark Nowell FRCS

Institution: Southmead Hospital, Bristol, UK.

Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.

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