TY - JOUR
T1 - Surgical management of primary tumors of the cervical spine
T2 - Surgical considerations and avoidance of complications
AU - Kaloostian, Paul E.
AU - Gokaslan, Ziya L.
PY - 2014/6
Y1 - 2014/6
N2 - Objective: Primary cervical spinal tumors are rare tumors of the spine and are associated with significant morbidity and mortality. Such tumors include multiple myeloma, chordomas, giant cell tumors, hemangiomas, osteosarcomas, chondrosarcomas, synovial sarcomas, aneurysmal bone cysts (ABC), hemangiomas, eosinophilic granulomas, osteoid osteomas, and osteoblastomas. We review the surgical decision-making process and identify critical key steps for surgical complication avoidance. We also present case illustrations demonstrating such pathological diagnoses and surgical treatments performed. Methods: We retrospectively review the literature regarding the most common primary cervical spinal tumors that have undergone surgical resection with or without adjuvant treatment. Results: En bloc resection of primary cervical tumors resulted in significantly increased progression-free survival and overall survival. From the limited data, adjuvant treatment with proton-beam therapy for chordomas has potential benefit. Neo-adjuvant chemotherapy for Ewing's sarcoma and osteogenic sarcoma has shown some promise, with en bloc resection demonstrating stronger benefit for osteogenic sarcoma. Discussion: En bloc resection for primary spinal tumors has proven to be the standard of care in spinal oncology. Adjuvant and neo-adjuvant treatments such as chemotherapy and radiotherapy variants (conventional, proton beam, cyberknife) need to be studied further in most primary tumor types to become standard of care. Chordoma management is more widely studied with en bloc resection and adjuvant proton-beam therapy demonstrating improved progression-free survival and overall survival. Surgical management and adjuvant treatment strategies are case dependent, depending on tumor histology, patient neurological examination, prior surgeries at that level, and prior adjuvant treatment.
AB - Objective: Primary cervical spinal tumors are rare tumors of the spine and are associated with significant morbidity and mortality. Such tumors include multiple myeloma, chordomas, giant cell tumors, hemangiomas, osteosarcomas, chondrosarcomas, synovial sarcomas, aneurysmal bone cysts (ABC), hemangiomas, eosinophilic granulomas, osteoid osteomas, and osteoblastomas. We review the surgical decision-making process and identify critical key steps for surgical complication avoidance. We also present case illustrations demonstrating such pathological diagnoses and surgical treatments performed. Methods: We retrospectively review the literature regarding the most common primary cervical spinal tumors that have undergone surgical resection with or without adjuvant treatment. Results: En bloc resection of primary cervical tumors resulted in significantly increased progression-free survival and overall survival. From the limited data, adjuvant treatment with proton-beam therapy for chordomas has potential benefit. Neo-adjuvant chemotherapy for Ewing's sarcoma and osteogenic sarcoma has shown some promise, with en bloc resection demonstrating stronger benefit for osteogenic sarcoma. Discussion: En bloc resection for primary spinal tumors has proven to be the standard of care in spinal oncology. Adjuvant and neo-adjuvant treatments such as chemotherapy and radiotherapy variants (conventional, proton beam, cyberknife) need to be studied further in most primary tumor types to become standard of care. Chordoma management is more widely studied with en bloc resection and adjuvant proton-beam therapy demonstrating improved progression-free survival and overall survival. Surgical management and adjuvant treatment strategies are case dependent, depending on tumor histology, patient neurological examination, prior surgeries at that level, and prior adjuvant treatment.
KW - Cervical spine
KW - En bloc
KW - Primary tumors
KW - Spinal chordomas
KW - Spinal complication
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U2 - 10.1179/1743132814Y.0000000367
DO - 10.1179/1743132814Y.0000000367
M3 - Article
C2 - 24716731
AN - SCOPUS:84901500955
SN - 0161-6412
VL - 36
SP - 557
EP - 565
JO - Neurological research
JF - Neurological research
IS - 6
ER -