Primary tumors of the cervical spine: a retrospective review of 35 surgically managed cases

Abstract

Background context

Primary tumors of the cervical spine are rare, and many issues regarding their surgical management remain unanswered yet.

Purpose

To demonstrate results of surgery for primary tumors of the cervical spine and to elucidate which factors influence outcome.

Study design/setting

Retrospective study.

Patient sample

Sixty-six surgeries were performed on 35 patients, ranging in age from 7 to 70 years.

Outcome measures

Preoperative and postoperative degree of pain and neurological status were quantified. Radiological investigations were used to detect recurrence and evaluate the stability and fusion.

Methods

Data were collected on patient characteristics, therapy, and results. Follow-up ranged from 6 months to 15 years (mean 59.9 months).

Results

Posterior (26), anterolateral (24), retropharyngeal (9), combined (4), lateral (2), and transmandibular approaches (1) were used. Chordomas (n=8) and 17 different types of tumors were encountered. One patient died 3 weeks postoperatively and 5 died of their disease at follow-up. Twenty patients had no evidence of disease, and 7 patients had recurrent tumors. According to the Weinstein-Boriani-Biagini classification, tumor extension into both anterior and posterior columns of a vertebra was correlated with a poor outcome. Incomplete resections resulted in tumor recurrence which warranted subsequent surgeries (up to 9), especially in chordoma cases.

Conclusions

Complete tumor resection is the oncologically best surgical strategy and should be attempted whenever possible. However, this may not be feasible in every case because of the complexity of the cervical spine. In these cases, acceptable mortality-morbidity rates and symptom-free years could be achieved by subtotal resections, even for malignant tumors.

Introduction

Primary tumors of the cervical spine are rare, and include benign variants such as osteoid osteomas, hemangiomas, giant cell tumors, as well as malignant lesions such as chordomas, plasmacytomas, and osteosarcomas [1]. Given that these tumors typically manifest neck pain as the initial symptom, it is not uncommon that neoplasms of the cervical spine are diagnosed late in their disease course. Because of their location in an anatomically complex region, often impinging on vascular and neural structures, they pose a technically challenging surgical problem; en bloc resection, though the most oncologically appropriate surgical treatment for most tumors, is very difficult [1]. The paucity of surgical series primarily focused on primary cervical spine tumors renders it difficult for clinicians to compare treatment efforts and results and make decisions about optimal treatments.

This report presents our experience in a surgical series of patients harboring primary cervical spine tumors. Special emphasis was placed on differences of chordoma cases, a challenging subgroup. Results of the surgical management were reviewed and clinical features were analyzed to elucidate which factors influence patient outcome.