Posterior Nerve–Sparing Multilevel Cervical Corpectomy and Reconstruction for Metastatic Cervical Spine Tumors: Case Report and Literature Review

Abstract

Cervical spine metastases with circumferential spinal cord compression often are treated with combined anteroposterior decompression and stabilization. In patients with large anterior neck masses, previous radiotherapy to the neck, or previous anterior neck surgery, however, anterior approaches may pose additional risk. In such cases, posterior-only approaches that allow for circumferential decompression and anterior column reconstruction may be beneficial. We present the case of a 70-year-old man with follicular thyroid carcinoma metastatic to the cervical spine causing spinal cord compression. We used a posterior-only approach for a C6-C7 partial corpectomy and posterior decompression and fusion from C2 to T2. Our technique involved preoperative embolization of the right vertebral artery to safely gain access to the ventral surface of the spinal cord and vertebral bodies. Anterior column support was provided by a chest tube/polymethylmethacrylate construct, allowing the implant to be placed within the anterior column from a posterior approach without nerve root sacrifice. The patient tolerated the procedure well. He had no postoperative neurologic deficits. Two months later, he underwent a total thyroidectomy followed by stereotactic radiotherapy to the tumor bed (2700 cGy total, 3 fractions). At 1-year follow-up, he was active and without significant pain or focal neurologic deficits. We propose a novel approach to ventral/circumferential cervical spine tumors that combines epidural decompression and cervical stabilization via a posterior-only approach. By using a chest tube/polymethylmethacrylate construct, anterior column support can be achieved through a posterior approach without nerve root sacrifice.