Tumour surgery of the upper cervical spine--a retrospective study of 13 cases
A series of tumour cases of the upper cervical spine who we had treated was analysed retrospectively with respect to surgical complications, quality of life and survival, 13 patients (mean age 56 years, metastases 6, plasmocytomas 3, chordomas 2, histiocytosis 1, aneurysmal bone cyst 1) with tumours of the upper cervical spine (C2 n = 7, C2 and C3 n = 4, C3 n = 2) were treated during an 8-year period. A total of 16 operations were carried out with ten one-step procedures and three two step-procedures. Eight extra-oral, one transoral, three dorsal and, in one case, a combined dorsal and extra-oral tumour removal were performed. Four dorsal stabilisation's, four ventral platings and two combined ventral platings plus dorsal fixations and eight vertebral body replacements were carried out. The neurological status and the quality of life were analysed preoperatively and during the follow-up examinations. Flexionextension radiographs were taken during follow-up. There was no operative mortality. The transient morbidity was 8%. The operative intervention significantly improved the quality of life in all patients during the follow-up visits (mean: 20 months). No instability was seen. The average survival time of all patients was 23 months. Six patients died following the operation after a mean time of 28 (4-64) months. Tumour removal in the upper cervical spine using individually modified surgical strategies based on an approach combining tumour location, stabilisation and vertebral body replacement significantly increases the time of survival and quality of life with an acceptable surgical risk for complications.