Cervical and thoracic spine tumor management: surgical indications, techniques, and outcomes

Since the first pioneering work in the area of tumors of the spine, medical professionals have sought to determine the proper role of spine surgery in the management of spinal tumors. Experience has proven that spine surgery is effective in the treatment of spinal cord compression for decreasing pain and improving quality of life with low rates of surgical complications. We use several staging systems to assess the patient's prognosis, to determine the best type of tumoral resection in preoperative surgical planning, and to provide guidance as to the best therapeutic option for the patient. In the surgical treatment of spine tumors, one of two opposing strategies must be chosen: (1) palliative surgery with cord decompression and spine stabilization or (2) curative surgery with en bloc radical resection of the tumor and stabilization. In this article, we describe indications and surgical techniques related to cervical spinal tumors: fixation and laminectomy of the upper and lower cervical spines, corporectomy, and partial and total vertebrectomy. For tumors of the cervicothoracic region, the most frequent level of spine metastasis and thoracic spine tumors, we describe the fixation and laminectomy technique, en bloc tumor resection, and partial and total vertebrectomy. The last part of the article addresses outcomes following spinal surgery, including outcomes related to en bloc Pancoast Tobias tumor resection, malignant dumbbell schwanomas, and metastasis.