Primary tumors of the cervical spine: a retrospective review of 35 surgically managed cases Mehmet Zileli, MD a, * , Cumhur Kilinc ¸er, MD b , Yusuf Ersahin, MD a , Sedat C ¸ agli, MD a a Department of Neurosurgery, Ege University Faculty of Medicine, Bornova, Izmir 35100, Turkey b Department of Neurosurgery, Trakya University Faculty of Medicine, Edirne, 22050, Turkey Received 20 October 2005; accepted 7 April 2006 Abstract BACKGROUND CONTEXT: Primary tumors of the cervical spine are rare, and many issues regarding their surgical management remain unanswered yet. PURPOSE: To demonstrate results of surgery for primary tumors of the cervical spine and to elu- cidate which factors influence outcome. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Sixty-six surgeries were performed on 35 patients, ranging in age from 7 to 70 years. OUTCOME MEASURES: Preoperative and postoperative degree of pain and neurological status were quantified. Radiological investigations were used to detect recurrence and evaluate the stabil- ity and fusion. METHODS: Data were collected on patient characteristics, therapy, and results. Follow-up ranged from 6 months to 15 years (mean 59.9 months). RESULTS: Posterior (26), anterolateral (24), retropharyngeal (9), combined (4), lateral (2), and transmandibular approaches (1) were used. Chordomas (n58) and 17 different types of tumors were encountered. One patient died 3 weeks postoperatively and 5 died of their disease at follow-up. Twenty patients had no evidence of disease, and 7 patients had recurrent tumors. According to the Weinstein-Boriani-Biagini classification, tumor extension into both anterior and posterior col- umns of a vertebra was correlated with a poor outcome. Incomplete resections resulted in tumor recurrence which warranted subsequent surgeries (up to 9), especially in chordoma cases. CONCLUSIONS: Complete tumor resection is the oncologically best surgical strategy and should be attempted whenever possible. However, this may not be feasible in every case because of the complexity of the cervical spine. In these cases, acceptable mortality-morbidity rates and symp- tom-free years could be achieved by subtotal resections, even for malignant tumors. Ó 2007 Elsevier Inc. All rights reserved. Keywords: Bone neoplasm; Cervical vertebrae; Chordoma; Operative surgical procedures; Recurrence; Spinal neoplasms Introduction Primary tumors of the cervical spine are rare, and include benign variants such as osteoid osteomas, hemangiomas, giant cell tumors, as well as malignant lesions such as chor- domas, plasmacytomas, and osteosarcomas [1]. Given that these tumors typically manifest neck pain as the initial symp- tom, it is not uncommon that neoplasms of the cervical spine are diagnosed late in their disease course. Because of their lo- cation in an anatomically complex region, often impinging on vascular and neural structures, they pose a technically challenging surgical problem; en bloc resection, though the most oncologically appropriate surgical treatment for most tumors, is very difficult [1]. The paucity of surgical series primarily focused on primary cervical spine tumors renders it difficult for clinicians to compare treatment efforts and results and make decisions about optimal treatments. FDA device/drug status: approved for this indication (cervical plate; occipitocervical plate; lateral mass plate). This article was presented at the 7th International Congress on Spine, Belek-Antalya, April 2005. Nothing of value received from a commercial entity related to this manuscript. * Corresponding author. Ege University Faculty of Medicine, Depart- ment of Neurosurgery, Bornova, Izmir 35100 Turkey. Tel.: þ90-232- 4219323; fax: þ90-232-4637751. E-mail address: mehmet.zileli@ege.edu.tr (M. Zileli) 1529-9430/07/$ – see front matter Ó 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2006.04.027 The Spine Journal 7 (2007) 165–173