Neoplasms of the Cervical Spine: Diagnostic Workup and Clinical Decision-making Algorithms

Narrative review.

To synthesize current evidence on diagnostics and clinical decision-making for patients with cervical spine neoplasms.

Although the cervical spine is disproportionately affected by primary spinal tumors and is the predominant site for intramedullary spinal cord tumors, there remains a relative paucity of reviews focused specifically on cervical spine neoplasms.

PubMed and Scopus were searched using a combination of terms related to cervical spine neoplasms, classification schemas, diagnostic evaluation, staging, and clinical decision-making. Supplemental targeted searches evaluated spinal oncology staging and treatment frameworks. Reference lists of articles and major reviews were screened for additional studies.

Cervical spinal tumors are classified by anatomic compartment as intramedullary, intradural extramedullary, or extradural, with pathologic diagnosis described by the 2021 World Health Organization (WHO) Classification of Tumors of the Central Nervous System and the 2020 WHO Classification of Soft Tissue and Bone Tumors. Diagnosis integrates clinical symptoms with a multimodal imaging approach that incorporates magnetic resonance imaging, computed tomography, positron emission tomography/computed tomography, vascular imaging, and adjunctive modalities such as diffusion tensor imaging tractography. Tissue biopsy remains central to diagnosis, with indications, contraindications, and technique selection guided by lesion characteristics and compartment. Liquid biopsy through cerebrospinal fluid-based circulating tumor DNA analysis has also emerged as a promising minimally invasive alternative for intramedullary lesions. Clinical decision-making frameworks have evolved considerably, from early anatomic staging systems through neurological and instability assessments to modern comprehensive treatment algorithms. Multidisciplinary tumor boards are essential for integrating medical, surgical, and radiation oncology expertise and individualizing care for these patients.

Cervical spine neoplasms are a diagnostically and therapeutically challenging subset of spinal tumors, encompassing a heterogeneous spectrum of primary and metastatic lesions. A multimodal, multidisciplinary approach is essential to optimize diagnostic accuracy, clinical decision-making, and individualized patient care.