Management of Cervical Spine Metastasis from Renal Cell Carcinoma: A Rare Case Report with an Overview

Renal cell carcinoma (RCC) accounts for 2-3% of adult malignant tumors, often metastasizing to bones, especially the spine. Spinal metastasis has a poor prognosis, but solitary spinal tumors have better outcomes with targeted chemotherapy, radiotherapy, and newer surgical approaches. Due to RCC's high vascularity and resistance to treatments, en bloc vertebrectomy with anterior and posterior fixation is the gold standard for solitary lesions. This case report discusses a young man with C-7 cervical vertebrae metastasis, causing right upper limb weakness and severe neck pain.

A 43-year-old male presented with 4 weeks of neck pain (visual analogue scale score 7) radiating to the right upper limb, with tingling and numbness. Examination showed C7 tenderness, decreased power (4/5) in C7 and C8, and 50% reduced sensation. MRI revealed a metastatic hyperintense lesion at C7 causing collapse, anterior and posterior cortex bulging, anterior thecal sac indentation, and left neural foramen narrowing. He underwent anterior cervical thoracic exploration (C6-T1) with partial sternotomy, tumor excision, C7 corpectomy, cord decompression, MESH cage insertion, and anterior cervical plate fixation, followed by posterior C5-C6 lateral mass and T1-T2 pedicle screw fixation. Neurological power in C7-C8 improved from 4/5 to 5/5, and sensation reduction improved from 50% preoperatively to 10% at 12 weeks.

Advancements in primary disease treatment necessitate evolving strategies for cervicothoracic metastasis. Combining extensive anterior and posterior techniques is now standard, enhancing patient quality of life through effective support and stabilization. Early diagnosis and referral are essential for pain relief and preventing neurological deficits and cord compression. Total en bloc vertebrectomy, the gold standard for solitary spinal metastasis, should include pre-operative embolization to reduce intraoperative bleeding. Prognosis relies on timely diagnosis, histological grading, and a comprehensive approach incorporating both medical and surgical treatments.