Surgical strategies for radical resections in subaxial cervical spine tumors

Radical resection of subaxial cervical spine tumors is challenging. This study evaluates outcomes following these extensive procedures.

We retrospectively reviewed 24 patients (mean age 38.8 yrs) treated (2002-2022) for subaxial cervical tumors (8 benign, 10 primary malignant, 6 metastatic). Procedures included total en bloc spondylectomy (TES, n = 9), total piecemeal spondylectomy (TPS, n = 6), and en bloc tumor resection (ETR, n = 9). Outcomes assessed included radiographic fusion, functional status (Visual Analog Scale [VAS]/Neck Disability Index [NDI]), complications, local recurrence, and survival. Paired t-tests and Kaplan-Meier/log-rank tests were used for statistical analysis.

Mean follow-up was 62 months. Benign tumor patients (ETR) experienced no recurrences or major complications and showed significant VAS/NDI improvement (p < 0.05). Primary malignant tumor patients (TES/TPS/ETR) had no local recurrence but suffered higher mortality (6/10 deaths; 4 disease-related) and complications (vertebral artery injury, cerebrospinal fluid leak, nerve injury), along with significant VAS/NDI improvement (p < 0.05). Metastatic tumor patients (TES/TPS) had no local recurrence or intraoperative complications; 50 % of these patients died from systemic disease. Significant VAS/NDI improvement was also achieved (p < 0.05). Radiographic fusion was confirmed in all the patients where bone grafts were applied (n = 21). Overall survival differed significantly by tumor type (p = 0.0395), with a significant trend across groups (p = 0.0340).

Radical resection for selected subaxial cervical tumors achieved high fusion rates, significant functional improvement, and excellent local tumor control. However, inherent risks of severe complications exist, particularly with malignant tumors. Survival varied significantly by histology. Current data preclude definitive conclusions on the comparative oncological efficacy of en bloc versus piecemeal techniques.