Skip to main content

Posterior Subaxial Cervical Approach and Stabilization

  • Chapter
  • First Online:
Spinal Tumor Surgery

Abstract

Tumors of subaxial cervical spine, though rare, can significantly impact a patient’s quality of life. Surgical management is complex, and decision-making depends on clinical presentation, histology, stage, and grade of the tumor. A posterior cervical approach is commonly used for lesions involving the posterior elements, causing significant spinal canal compromise, or in combination with an approach for tumors of the anterior column. Optimizing outcomes in spinal tumor patients focuses on preservation of function and prevention of complications that can delay life-prolonging adjuvant treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Quan GM, Vital J-M, Pointillart V. Outcomes of palliative surgery in metastatic disease of the cervical and cervicothoracic spine. J Neurosurg Spine. 2011;14(5):612–8.

    Article  Google Scholar 

  2. Abdu WA, Provencher M. Primary bone and metastatic tumors of the cervical spine. Spine. 1998;23(24):2767–77.

    Article  CAS  Google Scholar 

  3. Mesfin A, Sciubba DM, Dea N, Nater A, Bird JE, Quraishi NA, et al. Changing the adverse event profile in metastatic spine surgery: an evidence-based approach to target wound complications and instrumentation failure. Spine. 2016;41(Suppl 20):S262–70.

    Article  Google Scholar 

  4. Ibrahim A, Crockard A, Antonietti P, Boriani S, BĂ¼nger C, Gasbarrini A, et al. Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007. J Neurosurg Spine. 2008;8(3):271–8.

    Article  Google Scholar 

  5. Di Lorenzo N, Delfini R, Ciappetta P, Cantore G, Fortuna A. Primary tumors of the cervical spine: surgical experience with 38 cases. Surg Neurol. 1992;38(1):12–8.

    Article  Google Scholar 

  6. Rao S, Badani K, Schildhauer T, Borges M. Metastatic malignancy of the cervical spine. A nonoperative history. Spine. 1992;17(10 Suppl):S407–12.

    Article  CAS  Google Scholar 

  7. Arutyunyan GG, Clarke MJ. Management of primary and metastatic spinal tumors. J Neurosurg Sci. 2015;59(2):181–93.

    CAS  PubMed  Google Scholar 

  8. Schiff D, O’Neill BP, Suman VJ. Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach. Neurology. 1997;49(2):452–6.

    Article  CAS  Google Scholar 

  9. Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R. En bloc resections in the spine: the experience of 220 patients during 25 years. World Neurosurg. 2017;98:217–29.

    Article  Google Scholar 

  10. Clarke MJ, Mendel E, Vrionis FD. Primary spine tumors: diagnosis and treatment. Cancer Control. 2014;21(2):114–23.

    Article  Google Scholar 

  11. Tomita K, Kawahara N, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci. 2006;11(1):3–12.

    Article  Google Scholar 

  12. Davarski AN, Kitov BD, Zhelyazkov CB, Raykov SD, Kehayov II, Koev IG, et al. Surgical management of metastatic tumors of the cervical spine. Folia Med. 2013;55(3–4):39–45.

    Article  Google Scholar 

  13. Laufer I, Sciubba DM, Madera M, Bydon A, Witham TJ, Gokaslan ZL, et al. Surgical management of metastatic spinal tumors. Cancer Control. 2012;19(2):122–8.

    Article  CAS  Google Scholar 

  14. Fehlings MG, David KS, Vialle L, Vialle E, Setzer M, Vrionis FD. Decision making in the surgical treatment of cervical spine metastases. Spine. 2009;34(22 Suppl):S108–17.

    Article  Google Scholar 

  15. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.

    Article  Google Scholar 

  16. Sundaresan N, Steinberger AA, Moore F, Sachdev VP, Krol G, Hough L, et al. Indications and results of combined anterior-posterior approaches for spine tumor surgery. J Neurosurg. 1996;85(3):438–46.

    Article  CAS  Google Scholar 

  17. Rupp RE, Ebraheim NA, Coombs RJ. Magnetic resonance imaging differentiation of compression spine fractures or vertebral lesions caused by osteoporosis or tumor. Spine. 1995;20(23):2499–503; discussion 2504.

    Article  CAS  Google Scholar 

  18. Kurd MF, Millhouse PW, Schroeder GD, Kepler CK, Vaccaro AR. Lateral mass fixation in the subaxial cervical spine. J Spinal Disord Tech. 2015;28(7):259–63.

    Article  Google Scholar 

  19. Kumar A, Weber MH, Gokaslan Z, Wolinsky J-P, Schmidt M, Rhines L, et al. Metastatic spinal cord compression and steroid treatment: a systematic review. Clin Spine Surg. 2017;30(4):156–63.

    Article  Google Scholar 

  20. Kelleher MO, Tan G, Sarjeant R, Fehlings MG. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine. 2008;8(3):215–21.

    Article  Google Scholar 

  21. Clarke MJ, Zadnik PL, Groves ML, Sciubba DM, Witham TF, Bydon A, et al. Fusion following lateral mass reconstruction in the cervical spine. J Neurosurg Spine. 2015;22(2):139–50.

    Article  Google Scholar 

  22. Breslau J, Eskridge JM. Preoperative embolization of spinal tumors. J Vasc Interv Radiol. 1995;6(6):871–5.

    Article  CAS  Google Scholar 

  23. Broaddus WC, Grady MS, Delashaw JB Jr, Ferguson RD, Jane JA. Preoperative superselective arteriolar embolization: a new approach to enhance resectability of spinal tumors. Neurosurgery. 1990;27(5):755–9.

    Article  CAS  Google Scholar 

  24. Gellad FE, Sadato N, Numaguchi Y, Levine AM. Vascular metastatic lesions of the spine: preoperative embolization. Radiology. 1990;176(3):683–6.

    Article  CAS  Google Scholar 

  25. Smith TP, Gray L, Weinstein JN, Richardson WJ, Payne CS. Preoperative transarterial embolization of spinal column neoplasms. J Vasc Interv Radiol. 1995;6(6):863–9.

    Article  CAS  Google Scholar 

  26. Eldin MM, Hassan ASA. Free hand technique of cervical lateral mass screw fixation. J Craniovertebr Junction Spine. 2017;8(2):113–8.

    Article  Google Scholar 

  27. Ebraheim NA, Klausner T, Xu R, Yeasting RA. Safe lateral-mass screw lengths in the Roy-Camille and Magerl techniques. An anatomic study. Spine. 1998;23(16):1739–42.

    Article  CAS  Google Scholar 

  28. Coe JD, Vaccaro AR, Dailey AT, Skolasky RL Jr, Sasso RC, Ludwig SC, et al. Lateral mass screw fixation in the cervical spine: a systematic literature review. J Bone Joint Surg Am. 2013;95(23):2136–43.

    Article  Google Scholar 

  29. Yang W, Jiang L, Liu X, Wei F, Yu M, Wu F, et al. Surgical complications of extraspinal tumors in the cervical spine: a report of 110 cases and literature review. Eur Spine J [Internet]. 2017. Available from: https://doi.org/10.1007/s00586-017-5259-4.

    Article  Google Scholar 

  30. Clarke MJ, Vrionis FD. Spinal tumor surgery: management and the avoidance of complications. Cancer Control. 2014;21(2):124–32.

    Article  Google Scholar 

  31. O’Neill KR, Smith JG, Abtahi AM, Archer KR, Spengler DM, McGirt MJ, et al. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J. 2011;11(7):641–6.

    Article  Google Scholar 

  32. Theologis AA, Demirkiran G, Callahan M, Pekmezci M, Ames C, Deviren V. Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis. Spine. 2014;39(22):1875–80.

    Article  Google Scholar 

  33. Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine. 2011;36(24):2084–8.

    Article  Google Scholar 

  34. Itshayek E, Yamada J, Bilsky M, Schmidt M, Shaffrey C, Gerszten P, et al. Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol. 2010;36(3):533–44.

    PubMed  Google Scholar 

  35. Planchard RF, Maloney PR, Mallory GW, Puffer RC, Spinner RJ, Nassr A, et al. Postoperative delayed cervical palsies: understanding the etiology. Global Spine J. 2016;6(6):571–83.

    Article  Google Scholar 

  36. Thompson SE, Smith ZA, Hsu WK, Nassr A, Mroz TE, Fish DE, et al. C5 palsy after cervical spine surgery: a multicenter retrospective review of 59 cases. Global Spine J. 2017;7(1 Suppl):64S–70S.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michelle J. Clarke .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Shepherd, D.L., Clarke, M.J. (2019). Posterior Subaxial Cervical Approach and Stabilization. In: Sciubba, D. (eds) Spinal Tumor Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-98422-3_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98422-3_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98421-6

  • Online ISBN: 978-3-319-98422-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics