Surgical management of cervical spine metastasis: an update

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2026-05-01 Epub Date: 2026-04-25 DOI:10.1016/j.neuchi.2026.101814

Maria Rossella Fasinella , Louis Anzalone , Alexandre Meynard , Cédric Barrey

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引用次数: 0

Abstract

Background

Management of cervical spine metastases (CSM) is uniquely challenging due to regional biomechanics and neurovascular proximity. This study evaluates surgical strategies, focusing on the shift from radicality to functional preservation and the importance of multidisciplinary integration.

Methods

A systematic literature search was conducted across PubMed, MEDLINE, and Google Scholar (2015–2025), using the string "cervical" AND "spine" AND "metastases". From an initial pool of 1134 articles, a multi-stage screening process based on title, abstract, and predefined eligibility criteria was performed. Inclusion was restricted to English-language studies reporting clear functional outcomes. A final selection of 18 high-quality articles was analyzed.

Results

Strategy is strictly region-dependent: C0-C2 requires posterior fusion to manage translational instability; subaxial (C3-C6) ventral decompression via anterior corpectomy often necessitates posterior reinforcement for torsional control; and cervicothoracic (C7-T1) lesions are best managed via posterior-only long-segment fixation to avoid invasive manubriotomy. Modern "tissue-sparing" tools, such as Separation Surgery, ECT, and Carbon-PEEK implants, significantly enhance the "oncological window" by facilitating safe, high-dose SBRT. Despite a 20% morbidity rate, surgery markedly improves Quality of Life within the first 6 months.

Conclusions

Surgical intervention for CSM should prioritize functional restoration and "oncological window" preservation. In patients with favorable performance status, proactive stabilization is justified regardless of tumor aggressiveness, provided that surgical goals remain realistic and a reasonable risk-benefit ratio is maintained within the limits of clinical appropriateness.

查看原文本刊更多论文

颈椎转移的外科治疗：最新进展。

背景：由于区域生物力学和神经血管邻近性，颈椎转移瘤（CSM）的治疗具有独特的挑战性。本研究评估手术策略，侧重于从根治性到功能保留的转变以及多学科整合的重要性。方法：系统检索PubMed、MEDLINE和谷歌Scholar（2015-2025）的文献，检索词为“cervical”、“spine”和“metastases”。从最初的1134篇文章中，根据标题、摘要和预定义的资格标准进行多阶段筛选。纳入仅限于报告明确功能结果的英语研究。最后选取了18篇高质量的文章进行分析。结果：策略严格依赖于区域：C0-C2需要后路融合来控制平移不稳定；前椎体切除术下行轴位（C3-C6）腹侧减压通常需要后路加固以控制扭转；颈胸（C7-T1）病变最好通过后路长节段固定来治疗，以避免侵入性胸膜切开术。现代“组织保留”工具，如分离手术、ECT和碳- peek植入物，通过促进安全、高剂量的SBRT，显著提高了“肿瘤窗口”。尽管有20%的发病率，手术在前6个月内显著改善了生活质量。结论：CSM的手术干预应优先考虑功能恢复和“肿瘤窗口”保留。对于表现良好的患者，无论肿瘤是否具有侵袭性，只要手术目标是现实的，并且在临床适宜的范围内保持合理的风险-收益比，就有必要进行主动稳定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.