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Abstract

Intradural extramedullary tumors constitute a significant burden of primary spinal neoplasms. These include spinal meningiomas, the minority of which are located ventral to the cord. This report presents anterior corpectomy with Simpson Grade II resection of a ventrally located spinal meningioma at C3, followed by vertebral body replacement with a polyetheretherketone (PEEK) cage. The composition of this implant is of particular importance to this case, as it is necessary to monitor for the common event of meningioma recurrence. A 73-year-old female presented with left-sided lower extremity numbness and upper motor neuron findings. Imaging of the cervical spine revealed a large intradural extramedullary mass consistent with a meningioma, causing displacement of the cord to the left. An anterior cervical discectomy and fusion approach was used for C3 corpectomy and tumor resection, and a carbon-PEEK implant was used for spinal stabilization. The procedure continued in an uncomplicated fashion, and the transient dysphagia experienced by the patient resolved swiftly with supportive care. At a two-year follow-up, the patient remains asymptomatic and shows no evidence of meningioma recurrence. PEEK's resilience and radiolucency proved instrumental in ensuring the stability of the construct, as well as facilitating follow-up imaging of the cervical spine without artifacts. This case demonstrates the use of the anterior approach for corpectomy with a carbon-PEEK implant for spinal stabilization in the context of a ventrally located spinal meningioma, a strategy that ensured maximal safe resection of the lesion and permitted detailed postoperative surveillance for tumor recurrence. The success of this surgery and the patient's postoperative course highlight the critical role of a tailored surgical strategy and advanced biomaterials in optimizing outcomes for complex spinal neoplasms.

Introduction

Intradural extramedullary tumors account for nearly two-thirds of primary spinal neoplasms and include meningiomas, schwannomas, and neurofibromas, each presenting unique diagnostic and therapeutic challenges. Spinal meningiomas constitute 25-30% of intradural extramedullary lesions but only 1.2-12% of all meningiomas, with 15-20% positioned ventral to the cord and the remainder dorsal or dorsolateral [1,2]. These tumors are known to cause spinal cord compression and require excision for definitive treatment. This is achieved through various approaches, depending on the location. An anterior approach excels for ventral cervical tumors, where the fascial planes offer free mobilization of structures anterior to the spine; however, it proves impractical in the thoracic spine, where thoracic structures may obstruct access. Surgical planning hinges on approach selection, stabilization, and follow-up imaging, striking a balance between tumor removal and preservation of neurological function and structural integrity.

This case involves the resection of a ventral C3 meningioma via an anterior approach, accompanied by corpectomy, followed by vertebral replacement using a polyetheretherketone (PEEK) implant, selected for its biocompatibility, resilience, and radiolucency, which is crucial for monitoring recurrence [3,4]. The anterior corridor enabled direct decompression, while the PEEK implant mitigated radiologic artifacting. The case highlights the tailored integration of technique and material choice in effectively managing such neoplasms.

Case Presentation

A 73-year-old female presented with left lower extremity numbness following a recent fall with a fractured metatarsal. Examination revealed myelopathic signs, including a positive Hoffman reflex on the left and a brisk 3+ deep tendon knee jerk reflex. Magnetic resonance imaging (MRI) of the cervical spine revealed a large intradural extramedullary mass located ventral to the spinal cord, localized to the C3 vertebral level, and causing significant spinal cord displacement to the left. Imaging findings were...(More)

For more info please read, Anterior Corpectomy and Vertebroplasty With Carbon-Polyetheretherketone (PEEK) Cage, by Cureus