Surgical management of metastatic tumors of the cervical spine

Abstract

OBJECTIVE: To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. PATIENTS AND METHODS: The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre-and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classifi cation. RESULTS: Seven patients had only one affected vertebra, 4 patients -two vertebrae, one patient -three vertebrae, 2 patients -four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient -three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial -in 2 patients. Anterior stabilization system ADD plus® (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient -posterior cervical stabilization system. CONCLUSIONS: Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justifi ed. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

“…Intra-operative neuromonitoring has been largely suggested in order to prevent surgical related spinal cord damage due to the high grade ESCC [2] , [81] , [82] . The aforementioned principle surgical principles of circumferential separation could also be applied – with different and specific approaches - for tumors involving the cervical or lumbar spine [83] , [84] , [85] .

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Decompression Surgery Options for Metastatic Cervical Spine Lesions

“…In the most severe cases, in patients with C1, C2, posterior access may be recommended 26 . Neurological complications and increasing pain syndrome may be grounds for immediate surgical intervention 27 . The benefits of posterior access for cervical metastases can alleviate pain, stabilize the spine, and improve the patient's quality of life 28 .…”

Comparing the efficacy and safety of cement-augmented fenestrated pedicle screws and conventional pedicle screw in surgery for spinal metastases: a retrospective comparative cohort study

“…There are various scoring systems for preoperative evaluation of surgical methods for spinal metastases, including the Tomita score ( 6 ), the modified Tokuhashi score ( 7 ), Tomita classification ( 8 ), Weinstein-Boriani-Biagini (WBB) classification ( 9 ), spinal instability neoplastic score (SINS) ( 10 ), neurologic, oncologic, mechanical stability, and systemic disease (NOMS) score ( 11 ) and Harrington score ( 12 ). According to various kinds of scores and types, total en-bloc spondylectomy (TES) surgery can achieve the purpose of local radical resection and reduce the local recurrence rate for patients with an expected survival time of more than 1-year, solitary oligometastases, and poor spinal stability ( 13 , 14 ).…”