Introduction: Spine is the most common site to have bony metastasis and up to 70% of patients with malignancy have risk of developing spine metastasis. As there is significant improvement in the diagnostic imaging, spine metastasis are detected much earlier. In this abstract, we present our series and outcome of cervical metastasis treated at our institution between 2008-2016.
Methods: After obtaining IRB approval a retrospective chart review of all the patients who underwent surgery for cervical metastasis during the period of 2008-2016 were identified. A detailed chart review was performed. Data on presenting symptoms, history and examination, imaging, operative records and follow up clinical notes, type of primary cancer, stage at presentation, preoperative interventions, history of adjuvant therapies (chemotherapy, radiotherapy, etc.), and complications were reviewed. Demographic factors, such as sex, age, race, and comorbidities were reviewed.
Results: We identified 14 patients with age range between 24-80years with neck pain being the most common presenting symptom and 3 of them due to compression fracture. The primary malignancy was noted to be melanoma(3), multiple myeloma(3), sarcomatoid carcinoma of lung(1), small cell lung cancer(1), male breast adenocarcinoma(1), esophageal adenocarcinoma(1), Hodgkin lymphoma(1), chondrosacroma(1), medullary thyroid(1) and osteoblastoma(1). 7 patients had previous radiation and 7 previous chemotherapy. A total 14 surgeries were performed on 13 patients with 9 decompression and fusion, 3 corpectomy, one minimally invasive decompression and one laser ablation. 4 patients had local recurrence of tumor as evaluated on MRI studies, 1 patient was documented to have disseminated disease and 1 died, the remaining 7 had no long term complications locally.
Conclusions: Cervical metastasis is less common than thoracic and lumbar spine with proportionally higher blood supply. Presentation involved symptoms of cord compression or cervical fracture. Cervical decompression definitely improves the quality of life but larger studies are required to demonstrate improved survival.
Patient Care: This research helps guiding spine surgeon regarding the use of surgery in selected patient to ensure optimal efficacy.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of spine surgery in management of cervical metastasis 2) Identify known complications of each surgical type.
References: Diagnosis and management of metastatic cervical spine tumors. Molina CA, Gokaslan ZL, Sciubba DM. Orthop Clin North Am. 2012 Jan;43(1):75-87, viii-ix. Epub 2011 Oct 22. Review. PMID: 22082631
Management of metastatic tumors of the spine: strategies and operative indications. Steinmetz MP, Mekhail A, Benzel EC. Neurosurg Focus. 2001 Dec 15;11(6):e2. Review. PMID: 16463994