title: Neurological and survival outcomes after surgical management of subaxial cervical spine metastases.
abstract: METHODS
  A clinical retrospective study.
  
  
  OBJECTIVE
  To investigate the clinical outcomes of surgery for cervical spine metastasis and identify factors affecting survival and neurological result.
  
  
  BACKGROUND
  Metastatic disease in the cervical spine is known to be a poorer prognosis than in thoracic and lumbar regions. Few reports focused on cervical spine metastasis are available.
  
  
  METHODS
  A retrospective analysis of medical records and radiological data was performed on 46 patients who underwent surgical treatment due to cervical spine metastasis from 2000 to 2010. The incidence of cervical metastasis, overall survival, progression-free survival, and neurological and pain outcomes were analyzed. In addition, factors affecting survival, local recurrence, and neurological and pain outcomes among the 46 study subjects were analyzed. These factors included; age, sex, primary tumor growth rate, preoperative disease-progression status (expressed with Tomita score), irradiation, timing of irradiation, postoperative adjuvant therapy, time of diagnosis of spinal metastasis, cord compression or foraminal invasion on magnetic resonance image, preoperative neurological status, and preoperative pain level.
  
  
  RESULTS
  The incidence of cervical metastasis was 17.3%. Mean postoperative overall survival was 16.89 months, the recurrence rate was 39.1%, and mean progression free survival was 11.82 months. Factors related to prolonged survival were slow primary tumor growth, low Tomita score, irradiation of the lesion, and postoperative adjuvant therapy. Postoperative adjuvant therapy was also found to be effective for preventing recurrence. Patients with high preoperative Japanese Orthopaedic Association Score achieved better neurological outcomes. Foraminal invasion was found to be negatively correlated with postoperative pain outcome.
  
  
  CONCLUSIONS
  Surgical management for subaxial cervical spinal metastasis was found to be effective in terms of neurological recovery and pain control. Furthermore, surgical treatment plus adjuvant therapy was found to achieve sufficient local control during postoperative follow-up.
authors.affiliation: Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea.
authors.forename: Wonik
authors.initials: W
authors.lastname: Cho
authors.forename: Ung-Kyu
authors.initials: UK
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects* / Q000401:mortality; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009460:Neurologic Examination; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D020127:Recovery of Function; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult