Advertisement

Posterior Subaxial Cervical Approach and Stabilization

  • Daniel L. Shepherd
  • Michelle J. Clarke
Chapter

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.

Keywords

Posterior cervical fixation Posterior cervical stabilization Subaxial spine Lateral mass screws Cervical tumor Cervical screws 

References

  1. 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.CrossRefGoogle Scholar
  2. 2.
    Abdu WA, Provencher M. Primary bone and metastatic tumors of the cervical spine. Spine. 1998;23(24):2767–77.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 4.
    Ibrahim A, Crockard A, Antonietti P, Boriani S, Bünger 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 7.
    Arutyunyan GG, Clarke MJ. Management of primary and metastatic spinal tumors. J Neurosurg Sci. 2015;59(2):181–93.PubMedGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 10.
    Clarke MJ, Mendel E, Vrionis FD. Primary spine tumors: diagnosis and treatment. Cancer Control. 2014;21(2):114–23.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 22.
    Breslau J, Eskridge JM. Preoperative embolization of spinal tumors. J Vasc Interv Radiol. 1995;6(6):871–5.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 24.
    Gellad FE, Sadato N, Numaguchi Y, Levine AM. Vascular metastatic lesions of the spine: preoperative embolization. Radiology. 1990;176(3):683–6.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 26.
    Eldin MM, Hassan ASA. Free hand technique of cervical lateral mass screw fixation. J Craniovertebr Junction Spine. 2017;8(2):113–8.CrossRefGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.CrossRefGoogle Scholar
  30. 30.
    Clarke MJ, Vrionis FD. Spinal tumor surgery: management and the avoidance of complications. Cancer Control. 2014;21(2):124–32.CrossRefGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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.PubMedGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Mayo Clinic, Department of NeurosurgeryRochesterUSA
  2. 2.Mayo Clinic, Department of Neurologic SurgeryRochesterUSA

Personalised recommendations