Posterior support alone as a stabilization surgery for subaxial cervical metastases with vertebral body collapse: A...

The cervical spine accounts for 8 to 20% of spinal metastases and often requires surgery for instability or metastatic epidural spinal cord compression. The anterior approach allows direct tumor removal but carries risks of vascular or esophageal injury, while the posterior approach offers safer indirect decompression. Whether posterior-only fixation without anterior reconstruction provides sufficient stability is uncertain. We retrospectively reviewed 46 patients who underwent surgery for ≥ 50% cervicothoracic vertebral collapse between 2017 and 2022. Thirty-five patients (anterior short-segment fixation, n = 19; posterior long-segment fixation, n = 16) were analyzed for mechanical failure, epidural spinal cord compression grade, complications, and pain outcomes. Mechanical failure occurred only in the anterior short-segment group, affecting 3 patients (15.8%). Two reoperations were performed in the anterior short-segment group. No significant differences were observed between groups in epidural compression grade, pain (numerical rating score ≥ 4), complications, local recurrence, or survival. Both groups showed significant pain reduction at 1 month. In a 30-day landmark multivariable analysis, early complications (hazard ratio 4.09, 95% confidence interval: 1.03-16.20, P = .045) were an independent risk factor for survival. These findings suggest that posterior-only fixation can be a feasible alternative for stabilizing subaxial cervical and cervicothoracic metastases with vertebral body collapse.