Metastatic tumors involving the cervical vertebrae: surgical palliation

Pain, weakness, or paralysis from involvement of the spinal cord and nerve roots secondary to invasion of the vertebrae by a malignant tumor often can be avoided or alleviated by stabilization of the spine. Twelve patients with neoplastic infiltration of the cervical vertebrae were so treated. The operation of wiring, augmentation bone-grafting, and decompression of the spinal cord was successful after conservative methods failed. Indications for operation were: (1) unremitting pain in the neck, not relieved by bracing or radiation therapy; (2) a major degree of vertebral destruction with loss, or impending loss, of support for the head; (3) collapse of a vertebral body; or (4) neural deficit from local tumor invasion. A classification of our twelve patients into three groups helped to delineate the surgical procedure needed. The value of obtaining spinal stability and a solid fusion above and below the tumor was evident in eleven patients. For almost all of their survival time, they were comfortable. Surgical treatment may not appreciably extend the lenght of a patient's survival, but it generally improves the patient's quality of life.