Surgical management of cervical spine metastasis: an update

Management of cervical spine metastases (CSM) is uniquely challenging due to regional biomechanics and neurovascular proximity. This study evaluates surgical strategies, focusing on the shift from radicality to functional preservation and the importance of multidisciplinary integration.

A systematic literature search was conducted across PubMed, MEDLINE, and Google Scholar (2015-2025), using the string "cervical" AND "spine" AND "metastases". From an initial pool of 1134 articles, a multi-stage screening process based on title, abstract, and predefined eligibility criteria was performed. Inclusion was restricted to English-language studies reporting clear functional outcomes. A final selection of 18 high-quality articles was analyzed.

Strategy is strictly region-dependent: C0-C2 requires posterior fusion to manage translational instability; subaxial (C3-C6) ventral decompression via anterior corpectomy often necessitates posterior reinforcement for torsional control; and cervicothoracic (C7-T1) lesions are best managed via posterior-only long-segment fixation to avoid invasive manubriotomy. Modern "tissue-sparing" tools, such as Separation Surgery, ECT, and Carbon-PEEK implants, significantly enhance the "oncological window" by facilitating safe, high-dose SBRT. Despite a 20% morbidity rate, surgery markedly improves Quality of Life within the first 6 months.

Surgical intervention for CSM should prioritize functional restoration and "oncological window" preservation. In patients with favorable performance status, proactive stabilization is justified regardless of tumor aggressiveness, provided that surgical goals remain realistic and a reasonable risk-benefit ratio is maintained within the limits of clinical appropriateness.