Surgical Indications and Planning in Cervical Spine Oncology

STUDY DESIGN: Narrative review of contemporary literature alongside institutional experience applying the NOMS framework to cervical spine tumors. OBJECTIVE: To supplement the NOMS framework with cervical spine-specific considerations: summary of background data.The NOMS framework provides a widely applicable approach to spinal oncology based on neurological, oncologic, mechanical, and systemic factors. METHODS: Contemporary literature and published institutional experience addressing cervical spine tumors were reviewed. RESULTS: Cervical spine tumors require region-specific modification of conventional NOMS decision-making. Mechanical considerations are particularly important at the occipitocervical and cervicothoracic junctions, where tumor-related or iatrogenic instability may necessitate extended constructs and careful fixation strategies.Systemic factors, including frailty, malnutrition, prior radiation, active therapy, and prognosis, remain critical determinants of surgical candidacy. Complex cases may require multidisciplinary planning. CONCLUSIONS: NOMS remains a useful foundation for cervical spine oncology but should be supplemented by region-specific anatomic and biomechanical considerations.Treatment should be individualized according to neurological compromise, tumor biology, mechanical stability, systemic disease, and surgical morbidity. As radiation and systemic therapies advance, surgery should primarily address decompression, stabilization, and tissue diagnosis rather than serve as a stand-alone modality for local control.