Dr. Mihir Bapat
Director
Institute of Spine Surgery
Minimal Invasive
Spine Surgery
Nanavati Super Speciality
Hospital, Mumbai
Dr. Amandeep Gujral
Consultant
Minimal Invasive
Spine Surgery
Nanavati Super Speciality
Hospital, Mumbai
Conquering a Tumour in a minimally invasive way
THE CASE
A 10-year old boy was admitted to Nanavati with complaints of neck
pain for the past 7 months with no response to medicines. The child’s
mother had also noticed the neck was beginning to tilt sideways and
its movements were gradually getting restricted. The severity of the
pain had increased in the past couple of weeks, causing the child
to have several sleepless nights. Often, he would wake up crying in
agony in the middle of night.
Any pain lasting for more than 4 weeks and not responding to
medicines warrants further investigations and thus a CT scan was
advised. CT scan showed a Tumour measuring 9mm x 12mm x 12mm.
It was located under the right lamina of C2 vertebra encroaching into
the right lateral mass, pedicle and vertebral artery foramen leaving
a thin rim of bone before it.
THE PROCEDURE
A surgical excision of the Tumour was deemed necessary. The
Tumour was inconveniently sandwiched between two vital structures
– the vertebral artery and the spinal cord leaving a thin zone of safe
surgical approach for the surgical team. Even a minor deviation in
the approach could have caused a vertebral artery or spinal cord
injury rendering the child permanently paralysed.
Taking into account all the prevalent conditions, a minimally invasive
posterior midline approach was utilised. After defining C 2/3 joint,
canal line, vertebral artery foramen, margins of C2; bone burring was
done along with C2 inferior articular facet towards central canal. The
vertebral artery foramen was opened and the artery was protected.
Thin shell of bone lining the spinal canal was separated with a nerve
hook. Cord position was seen and secured. The Tumour along with its
central nidus and surrounding zone of reactive bone was successfully
excised.
THE RESULT
The patient was able to independently move about next day post
surgery. A post operative CT scan confirmed the complete excision of
the Tumour ruling out any possibilities of recurrences. The child was
discharged on the second day and had an uneventful recovery. He was
permitted to start normal activities and resume school in 4 weeks post
surgery.
DISCUSSION
Osteoid Osteoma is one of the most common Benign Tumour affecting
the human skeleton. These Tumours usually involve the long bones
of the appendicular skeleton but involvement of vertebraes is not
uncommon.