Tumors of the Cervical Spine: Our Experience with 24 Cases

Introduction: Primary bone tumors located at the cervical spine are rare. They are either benign or malignant. Neck pain is the initial non-specific symptom, and they are diagnosed late in their disease course. Its location is in an anatomically complex region impinging on neurovascular structures. They are technically challenging surgical problems. Meticulous pre-operative preparation is mandatory. Enbloc resection is oncologically appropriate but is very difficult to achieve. We intend to analyze the surgical outcome of patients harboring primary cervical spine tumors.

Methods: Patients with primary bony tumors of the cervical spine operated at a tertiary centre between January 2010 and December 2023 were included. Data were collected on patient characteristics, presentation, site, extent, imaging findings, surgical intervention, complications, and outcome.

Results: A total of 24 patients with a mean age of 31.5 ± 2.57 years with a male: female ratio of 16: 8. The most common presenting complaint was neck pain in 54.1% (13 patients). The most common site was C2 (6, 4.1%). SINS score was >12 in 62.5% (15 patients). The extent of resection was tumor decompression in 54.1%, subtotal resection in 29.1%, en-bloc resection in 8.3%, injection of sclerotherapy in 4.1%, and biopsy in 4.1%. Approaches were anterior [retropharyngeal (2), anterolateral (2), 3 staged anteroposterior (2), transoral (4)], and posterior (14). A stabilization procedure using screw and rod fixation was done in 15 patients (62.5%). Three patients had recurrence at 2 years follow-up. Eighteen patients improved symptomatically. Nine patients received adjuvant therapy (radiotherapy and denosumab). One mortality at 3 months follow-up and 2 patients lost to follow-up.

Conclusion : Different types of bone tumors are found at the cervical spine. Biopsy is rarely required for diagnostic dilemma between benign and malignant tumors or pseudo tumors. Definitive treatment consists of complete tumor resection with complementary stabilization procedure if there is spinal instability. However, complete tumor resection may not be feasible due to complexity of cervical spine. Spinal instability should be anticipated preoperatively based on the extent and aggressiveness of the tumor.