AbstractPrimary tumors of the spine are uncommon and represent < 5% of all bone neoplasms as compared with secondary metastatic disease, multiple myeloma, and lymphoma. Moreover, the treatment of cervical spine tumors requires complex therapeutic and reconstructive strategies depending on the tumor’s pathology, location, aggressiveness, and proximity to the surrounding neurovascular structures, and influence the prognosis. A purpose of this study is to explore the clinical characters, surgical methods, and prognosis of the primary cervical spinal tumors. The subjects were 35 patients with an average age of 45 years, 20 male and 15 female. We examined the histological types, surgical methods, and prognosis. Malignant tumors were 11 including 4 chondromas, 3 chondrosarcomas, 1 angiosarcoma, fibrosarcoma, alveolar soft part sarcoma (ASPS), and epithelioid hemangioendothelioma. Intermediate tumors were two giant cell tumors (GCT), and benign tumors were 24 (8 osteochondromas, 6 osteoid osteomas, 3 Langerhans cell histiocytosis (LCH), 2 osteoblastoma, 1 Aneurysmal bone cyst (ABC), Pigmented villonodular synovitis (PVNS), and fibroma. As surgical methods, total resections with spinal reconstruction were performed in 21 cases (18 benign tumors, 2 GCT, and fibrosarcoma), subtotal resections in 10 cases (all of malignant tumors except for fibrosarcoma), and biopsies in 2 LCHs. Two cases (chondrosarcomas) underwent several surgeries for relapse. All of benign tumors showed no relapse and adequate bony healing. Eight of 11 malignant tumors were died on disease. Remaining 3 cases of disease free were 1 fibrosarcoma and 2 chordomas with adjuvant heavy particle beam therapy. Total resection has been difficult in some of these tumors, particularly malignant tumors, due to complicated anatomical features with vertebral artery and carotid sheath (highly risky anatomical region). The improvement of the further surgery technique and establishment of adjuvant therapy are expected in future.