General Editor: Luiz Vialle

Authors: Ilya Laufer, JJ Verlaan (on behalf of AOSpine Knowledge Forum Tumor)

Metastatic tumors Subaxial cervical, unstable, low ESCC

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Glossary

General considerations

The choice between an anterior and posterior approach will be determined by the individual case and preoperative imaging, taking into account the location of the tumor and the destruction of the spine.

Nonoperative treatment
Main indication Skill Equipment
Patient not fit for surgery due to medical comorbidities or very advanced metastatic disease. Basic surgical experience, no specialized skills Basic equipment only

Nonoperative treatment consists of radiotherapy, and if needed, brace stabilization to prevent ranges of motion that cause pain.

Anterior corpectomy and stabilzation
Main indication Skill Equipment
Gross destruction of the vertebral bodies without posterior involvement Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Contraindications

  • Extensive neck treatment including radiation and prior surgery

Advantages

  • Anterior column support
  • Favorable wound healing

Disadvantages

  • Risk of esophageal or vascular injury

 

Posterior stabilization C3-C7
Main indication Skill Equipment
Multilevel disease or circumferential tumors Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Advantages

  • Multilevel osseous fixation
  • Possibility to extend fixation to the thoracic spine

Disadvantages

  • Extensive paraspinal muscle dissection
  • Need for a longer construct compared to stand alone anterior approach
Posterior stabilization C7-T1
Main indication Skill Equipment
Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Advantages

  • Multilevel osseous fixation
  • Possibility to extend fixation to the thoracic spine

Disadvantages

  • Extensive paraspinal muscle dissection
  • Need for a longer construct compared to stand alone anterior approach
Combined anterior and posterior
Main indication Skill Equipment
Multilevel disease or circumferential tumors Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Since most cases can be solved by either an anterior or posterior approach, the combined approach is only indicated in rare cases.

Advantages

  • Multilevel osseous fixation

Disadvantages

  • Extensive paraspinal muscle dissection
  • Need for a longer construct compared to stand alone anterior approach
  • Risk of esophageal or vascular injury
  • Need for longer or multistage surgery
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

V1.0 2019.01.06