Surgical management of cervical malignant spinal lesions: a retrospective study of cervical spine metastases and multiple myeloma cases

Abstract

Purpose

This study introduces a retrospective analysis of the surgical management of 213 consecutive cases of cervical spine metastases and Multiple Myeloma Cases.

Materials and methods

Retrospective analysis of prospectively collected data in a single surgical center of patients who underwent surgery for tumors of the cervical spine between 1994 and 2017. Exclusion criteria were intradural tumors and primary tumors. We analyzed epidemiological data, clinical presentation, radiological findings, and treatment methods.

Results

From a total of 213 patients, 125 (59%) were male and 88 (41%) were female. The mean age was 61 years (range: 5 to 88 years). The most common entity was lung cancer (19.5%). In 5% of the cases, staging detected no primary (CUP). In most patients, a combined approach (96 patients; anterior-posterior in 80 cases, posterior-anterior in 16 cases) was needed for surgery. From an anterior approach, only 49 patients were treated, while in 68 cases, a posterior approach alone was sufficient. In the atlantoaxial group, in the majority of patients, a transoral approach was performed (30 cases), mostly combined with posterior stabilization (27 patients). The average number of stabilized segments was 2.8 (range: 0–10). The mean postoperative follow-up was 14.2 ± 9.44 months.

Conclusions

Most cervical spine metastases and multiple myeloma cases can be treated with long-term control or cure of the lesion and preservation of neurological function. Anterior approaches provide adequate exposure to safely remove most of these lesions. Nevertheless, combined surgery with varying degrees of complexity is often required.