Surgical treatment of tumors of the cervical spine and first two thoracic vertebrae.

From 1985 through 1990, 19 patients with tumorous conditions of the cervical spine and the first two thoracic vertebrae were treated with anterior, posterior, or combined anterior/posterior surgical techniques. Breast metastases were by far the most common condition (42%). Patients usually experienced severe pain, which resisted conservative treatment, sometimes associated with radiculopathies (42%) or neurological deficits (31%). To date, the treatment of spinal tumors is only palliative, and surgery must be considered for cases with unremitting neck pain, major vertebral destruction with loss, or impending loss of cervical spine stability and neurological deficits due to local tumor compression. Contrary to the commonly used posterior wiring stabilizations, we preferred stabilization techniques more closed to those used in traumatology. Our findings suggest anterior surgery alone with vertebrectomy and stabilization with plate and bone cement for tumors involving only one vertebra and localized between C3 and T1. Posterior approach and stabilization is advocated for atlantoaxial lesions. A combined anterior and posterior technique should be reserved for extended tumoral conditions where an anterior fixation does not offer enough stability or where more radical surgery is required. In the present series, immediate good spinal stabilization and neck pain relief was obtained in every case, allowing early mobilization. Improvement of the neurologic deficit was noted in 65% of our patients.