Outcomes of patients with cervical spine metastasis treated with different surgical approaches—decision based on location

The low incidence of cervical metastases and complex anatomical structure of cervical spine complicate surgical strategy formulation and make it controversial. By summarizing and analyzing clinical data of patients with metastatic cervical spine tumors, this study aims to investigate treatment decisions of separation surgery and outcomes of different approaches to provide clinical evidence and references. For atlantoaxial metastases, occipitocervical fixation with decompression (OPFD) was performed. In cases involving lower cervical spine, anterior cervical corpectomy (ACCP) or posterior cervical fixation with decompression (PCFD) was performed. When both vertebral body and appendices were affected, the choice of approach was based on surgeons’ personal preference and patient’s specific condition. Baseline characteristics, clinical manifestations, surgical approach, perioperative complications, and postoperative outcomes, including neurological function, pain level, and survival were compared between the surgical approaches. The most common symptom was neck pain (116/124). Twenty-three patients underwent posterior OPFD, 47 patients underwent ACCP, and 42 patients underwent PCFD. There were no significant differences in perioperative complications, and postoperative therapy among patients with lower cervical metastases. For cases with simultaneous involvement of vertebral body and appendices, patients who underwent PCFD had significantly longer survival than those who underwent ACCP (29.4 ± 14.9 vs. 19.7 ± 12.5, p = 0.028). The same phenomenon was observed in other two comparisons. All patients experienced varying degrees of pain relief with those undergoing posterior approach demonstrating significantly greater pain relief (p < 0.05). No neurological deterioration was observed postoperatively. Perioperative complication rate was 26.6%. Multivariate Cox analysis showed that surgical approach was independent risk factors for survival. For patients with cervical metastases, we made treatment decisions based on the specific location of tumor and requirements of separation surgery to ensure that patients receive subsequent comprehensive therapy. The discernible differences between surgical approaches were that patients who underwent posterior approach tended to have more significant pain relief and longer survival.