Comparison of Outcomes in Patients with Cervical Spine Metastasis After Different Surgical Approaches: A Single-Center Experience

Abstract

ObjectivesIn patients undergoing cervical spine surgery for metastatic spine disease, we sought to: 1) compare perioperative and oncologic outcomes among three different operative approaches, 2) report fusion rates, and 3) compare different types of anterior vertebral body replacement. MethodsA single-center, retrospective cohort study of patients undergoing extradural cervical/cervicothoracic spine metastasis surgery between 02/2010-01/2021 was conducted. Operative approaches were: anterior-alone, posterior-alone, or combined anterior-posterior, and the grafts/cages used in the anterior fusions were: cortical allograft, static cage, or expandable cage. All cages were willed with autograft/allograft. Outcomes included perioperative/postoperative variables, along with fusion rates, functional status, local recurrence (LR), and overall survival (OS). Results61 patients underwent cervical spine surgery for metastatic disease, including 11(18.0%) anterior, 28(45.9%) posterior, and 22(36.1%) combined. New postoperative neurologic deficit was the highest in the anterior approach group (p=0.038), and dysphagia was significantly higher in the combined approach group (p=0.001). LR (p>0.999), OS (p=0.655), and time to both outcomes (log-rank test: OS p=0.051, LR p=0.187) were not significantly different. Of the 51 patients alive at 3-months, only 19/51(37.2%) obtained imaging≥3-months. Fusion was seen in 11/19(57.8%) at a median(IQR) of 8.3(4.6-13.7)months. Among the anterior corpectomies, the following graft/cage were used: 6(54.5%) allograft, 4(36.3%) static cage, and 1(9.0%) expandable cage, with no difference was found in outcomes among the three groups. ConclusionThe only discernible differences between operative approaches were that patients undergoing an anterior approach had higher rates of new postoperative neurologic deficit, and the combined approach group had higher rates of postoperative dysphagia.