Cervicothoracic Metastatic Spine Disease

Abstract

The most common spinal column tumor type is metastasis from a secondary site. Spinal metastasis involving the cervical and thoracic region can cause nerve root and spinal cord compression. Thus decision regarding the timing of decompression is critical in order to preserve function and prevent additional spinal cord injury. The indications for surgery include disabling neck or back pain, spinal column deformity, new neurological deficit, and/or the presence of spinal cord compression. Additional factors to consider in the decision to operate include patient life expectancy and tumor type. In the surgical treatment of cervicothoracic metastasis, tumor removal and direct decompression should be the goal, often requiring corpectomy or vertebral body resection. In the cervical spine, anterior-only or combined anterior-posterior approaches can be taken for decompression and stabilization. In the thoracic region, there has been a push to utilizing posterior-only approaches for corpectomy and spinal instrumentation. However, indications still exist, although it is the vast minority of cases, where an anterior or lateral approach is utilized to access the vertebral body for tumor resection. Complications to surgery for metastasis vary based on whether operating on the cervical or thoracic spine, with lower complication rates when treating the cervical region.