Charan Makkina, Tony Varghese Panicker, Baylis Vivek Joseph
INTRODUCTION: Lesions of the C2 vertebral body represent a distinct and demanding subset of spinal pathology. The intricate anatomy of the upper cervical spine, characterized by its proximity to critical neurovascular structures, limited surgical corridors, and complex biomechanical demands, renders surgical intervention at this level particularly challenging.
ANATOMICAL CONSIDERATION AND SURGICAL RATIONALE: The odontoid process (dens) of C2 plays a pivotal role in the stability of the craniovertebral junction. When the tip of the odontoid is preserved despite partial vertebral body destruction, it remains a reliable anchor point for spinal fusion. Exploiting this anatomical advantage allows for anterior uninstrumented bone graft placement, thereby minimizing surgical morbidity.
STUDY OBJECTIVE AND SURGICAL TECHNIQUE: This article presents a retrospective review of six patients who presented with partial destruction of the C2 vertebral body and were managed surgically. The operative strategy employed consisted of three key components: Anterior median C2 corpectomy-targeted resection of the diseased vertebral body while preserving viable bony structuresReconstruction with autologous bone graft-restoration of anterior column integrity using iliac crest or fibular graft, using the osteogenic and biomechanical properties of autologous materialPosterior stabilization - supplementary fixation to ensure construct stability.
SIGNIFICANCE AND CONCLUSION: The findings of this review underscore the viability, safety, and clinical effectiveness of this surgical strategy (anterior corpectomy with uninstrumented fusion and posterior supplementary instrumented fusion) across a spectrum of pathological conditions affecting the C2 vertebra. By demonstrating its applicability in varied clinical scenarios, this technique offers a reproducible and practical framework for surgeons managing this challenging anatomical region.