title: Surgical management with radiation therapy for metastatic spinal tumors located on cervicothoracic junction : a single center study.
abstract: OBJECTIVE
  The cervicothoracic junction (CTJ) is a biomechanically and anatomically complex region that has traditionally posed problems for surgical access. In this retrospective study, we describe our clinical experiences of the treatment of metastatic spinal tumors at the CTJ and the results.
  
  
  METHODS
  From June 2006 to December 2011, 23 patients who underwent surgery for spinal tumors involving the CTJ were enrolled in our study. All of the patients were operated on through the posterior approach, and extent of resection was classified as radical, debulking, and simple neural decompression. Adjuvant radiation therapy (RT) was also considered. Visual analog scale score for pain assessment and Medical Research Council (MRC) grade for motor weakness were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG).
  
  
  RESULTS
  Almost all of the patients were operated using palliative surgical methods (91.3%, 21/23). Ten complications following surgery occurred and revision was performed in four patients. Of the 23 patients of this study, 22 showed significant pain relief according to their visual analogue scale scores. Concerning the aspect of neurological and functional recovery, mean MRC grade and ECOG score was significantly improved after surgery (p<0.05). In terms of survival, radiation therapy had a significant role. Median overall survival was 124 days after surgery, and the adjuvant-RT group (median 214 days) had longer survival times than prior-RT (63 days) group.
  
  
  CONCLUSIONS
  Although surgical procedure in CTJ may be difficult, we expect good clinical results by adopting a palliative posterior surgical method with appropriate preoperative preparation and postoperative treatment.
authors: Department of Neurosurgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Ho-Young
authors: HY
authors: Park
authors: Department of Neurosurgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Sun-Ho
authors: SH
authors: Lee
authors: Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Se-Jun
authors: SJ
authors: Park
authors: Department of Neurosurgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Eun-Sang
authors: ES
authors: Kim
authors: Department of Neurosurgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Chong-Suh
authors: CS
authors: Lee
authors: Department of Neurosurgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Whan
authors: W
authors: Eoh
keywords: Cervicothoracic junction; Metastatic spinal tumor; Treatment