Results of Surgical Treatment for Metastatic Cervical Spine Tumor

Hwang, Sang Won; Rhim, Seung Chul; Roh, Sung Woo; Jeon, Sang Ryong; Bae, Chae Wan

Abstract

OBJECTIVE
The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. This retrospective study was undertaken to analyze the results of surgery and the outcome of patients with extradural metastases in the cervical spine.
METHODS
Thirty-three patients with cervical spine metastases who underwent spinal surgery by two surgeon at a single center in a 14-year period(1993-2007) were analyzed. Indications for surgery include intractable pain, neurological deficits, spinal cord compression, and the need for stabilization of impending pathological fractures. Numerous factors affect outcome including the nature of the primary cancer, the presence of fracture or dislocation, approach of surgery, and the severity of spinal cord compression. The change of predominant symptoms and survival time were evaluated after surgery.
RESULTS
There were 17 male and 16 female patients aged from 29 to 78 years old(mean age, 59.9 years). Among the metastatic tumors, colon, breast, and liver were the most common primary sites of origin, and lung, kidney, stomach and thyroid were also common. All patients had bony invasion and 24 patients had pathologic vertebral fracture and 6 patients had dislocation. Based on the tumor location, approaches included 12 anterior, 6 posterior and 15 combined. Epidural spinal cord compression on the axial T2-weighted magnetic resonance(MR) image was noted in 31 patients(93.9%). The American Spinal Injury Association(ASIA) impairment scale scores in preoperative state were stable in 29 patients(87.9%) who presented with ASIA Score D and E. The most common predominant symptoms of patients were cervical and/or radiating pain(26 patients) and 23 patients had neurological deficits. At Follow-up, predominant preoperative symptoms improved in 28(84.8%) patients who had pain or neurological deficits. The overall mean survival duration for patients with cervical metastatic tumors after diagnosis was 7.4 months in 28 expired patients and 17.4 months in 5 survived patients. There were four major early and late complications in this study. One patient suffered from the immediate postoperative epidural hematoma and improved after evacuation of hematoma. There were three cases of instrumentation failure. One of them was symptomatic and underwent second-look surgery.
CONCLUSION
Surgery for the treatment of cervical spine metastases is effective for improvement of the neurological deficits and relief the local pain in a significant proportion of patients with acceptable complication rates. The tech- nical evolution of cervical implants has improved our ability to achieve long-term rigid fixation, particularly over the cervicothoracic junction.