title: Operative management of metastatic and malignant primary subaxial cervical tumors.
abstract: OBJECTIVE
  The authors describe the preoperative assessment, intraoperative strategies, and long-term outcomes in 41 consecutive patients who underwent spinal reconstruction after resection of subaxial cervical neoplasms.
  
  
  METHODS
  Thirty-three tumors were metastatic and eight were primary. Preoperative studies included direct laryngoscopy and vertebral artery (VA) balloon occlusion tests in selected patients. Based on the tumor location, approaches included 12 anterior, 13 posterior, and 16 combined. All patients underwent aggressive intralesional resection and spinal reconstruction. In 12 patients, the VA was dissected from the periphery of the tumor, two cases of which required ligation. Fibula allograft and an anterior rigid plate fixation were most commonly used for anterior reconstruction. Posterior reconstruction was initially performed using lateral mass plates (LMPs) in 13 patients and screw/rod systems in the remaining patients. At follow up, pain level improved to mild or was absent in 39 patients (95%) who had presented with moderate or severe pain. The American Spinal Injury Association (ASIA) Scale scores were stable in 25 patients who presented with ASIA Score E and improved in 14 patients (88%) who presented with ASIA Score B, C, or D. Functional radiculopathy significantly improved in 16 (94%) of 17 patients. Complications occurred in 10 patients (24%) and included three fixation failures requiring revision. Two fixation failures involved cervical LMP screw pullout. The overall mean survival duration was 8.6 months for patients with metastatic tumors and 33.4 months for primary tumors.
  
  
  CONCLUSIONS
  Surgery for the treatment of subaxial spine neoplasms is effective for relieving pain, encouraging functional nerve root recovery, and preserving spinal cord function with acceptable complication rates.
authors.affiliation: Neurosurgery, Head and Neck, and Orthopedic Services, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. bilskym@mskcc.org
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
authors.forename: Frederic
authors.initials: F
authors.lastname: Collignon
authors.forename: Dennis
authors.initials: D
authors.lastname: Kraus
authors.forename: Patrick
authors.initials: P
authors.lastname: Boland
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome