Primary tumors of the cervical spine: a retrospective review of 35 surgically managed cases.

BACKGROUND CONTEXT: Primary tumors of the cervical spine are rare, and many issues regarding their surgical management remain unanswered yet.

PURPOSE: To demonstrate results of surgery for primary tumors of the cervical spine and to elucidate which factors influence outcome.

STUDY DESIGN/SETTING: Retrospective study.

PATIENT SAMPLE: Sixty-six surgeries were performed on 35 patients, ranging in age from 7 to 70 years.

OUTCOME MEASURES: Preoperative and postoperative degree of pain and neurological status were quantified. Radiological investigations were used to detect recurrence and evaluate the stability and fusion.

METHODS: Data were collected on patient characteristics, therapy, and results. Follow-up ranged from 6 months to 15 years (mean 59.9 months).

RESULTS: Posterior (26), anterolateral (24), retropharyngeal (9), combined (4), lateral (2), and transmandibular approaches (1) were used. Chordomas (n=8) and 17 different types of tumors were encountered. One patient died 3 weeks postoperatively and 5 died of their disease at follow-up. Twenty patients had no evidence of disease, and 7 patients had recurrent tumors. According to the Weinstein-Boriani-Biagini classification, tumor extension into both anterior and posterior columns of a vertebra was correlated with a poor outcome. Incomplete resections resulted in tumor recurrence which warranted subsequent surgeries (up to 9), especially in chordoma cases.

CONCLUSIONS: Complete tumor resection is the oncologically best surgical strategy and should be attempted whenever possible. However, this may not be feasible in every case because of the complexity of the cervical spine. In these cases, acceptable mortality-morbidity rates and symptom-free years could be achieved by subtotal resections, even for malignant tumors.