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. |  |
 |
Nonoperative treatment consists of radiotherapy, and if needed, brace stabilization to prevent ranges of motion that cause pain.
| Anterior decompression and stabillzation | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Single level vertebral body tumors |  |
 |
Contraindications
- Extensive neck treatment including radiation and prior surgery
Advantages
- Shorter construct length
- Anterior column support
- Favorable wound healing
Disadvantages
- Risk of esophageal or vascular injury
- Limited options for nerve root decompressions
| Posterior decompression and stabilization C3-C7 | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Single/multilevel disease or circumferential tumors | |
|
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 decompression and stabilization C7-T1 | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Single/multilevel disease or circumferential tumors | |
|
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 with extensive loss of bone | |
|
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 |
 |
Some specialized surgical experience |
|
Highly experienced and skilled surgeon |
| *Equipment | |
|---|---|
|
Basic equipment only |
 |
Simple surgical and imaging resources |
|
Full specialized surgical and imaging resources |