Cervical Spine Oncology: Perioperative Management and Complications

STUDY DESIGN: Narrative review. OBJECTIVE: To synthesize contemporary evidence on perioperative complications in primary and metastatic cervical spine tumor surgery and to provide an evidence-informed framework for their prevention and management. SUMMARY OF BACKGROUND DATA: Cervical spine tumor surgery converges dense neurovascular and aerodigestive anatomy with a medically fragile, frequently irradiated patient population. Although cervical metastases represent only about 8-20% of spinal metastatic disease, their mismanagement carries disproportionately severe consequences, ranging from disabling pain to high-level paralysis and death. Cervical-specific risk-stratification tools are lacking, and most available evidence is extrapolated from degenerative anterior cervical cohorts. METHODS: This is a narrative review of perioperative complications in cervical spine oncology. PubMed/MEDLINE and Google Scholar were searched for English-language articles published through May 2026, prioritizing literature from the past 5 years while including seminal earlier references where foundational, using combinations of the terms "cervical spine," "spinal metastasis," "spinal tumor," "perioperative complications," "airway," "vertebral artery," "wound," "dysphagia," "venous thromboembolism," and "hardware failure." Reference lists of included articles were hand-searched for additional sources. Studies were selected by author consensus for relevance to the complication domains discussed; formal risk-of-bias assessment and quantitative pooling were not performed, consistent with a narrative design. Because oncology-specific evidence is limited, data derived from degenerative cervical cohorts are identified as such throughout. RESULTS: Major complication domains include airway compromise (highest with multilevel corpectomy, combined approaches, and cervicothoracic constructs), vascular and neurologic injury, CSF leak, wound failure and infection in irradiated fields, hardware failure, venous thromboembolism, and dysphagia. CONCLUSIONS: Outcomes depend on preoperative risk stratification, multidisciplinary coordination, and individualized postoperative care rather than any single intraoperative maneuver. Because the evidence base remains largely Level III-IV without validated cervical oncology-specific tools, described practices should be regarded as reasonable, evidence-informed considerations rather than standards of care.