Tumor surgery at the upper cervical spine [Tumorchirurgie an der oberen Halswirbelsäule]

Our own series of tumors of the upper cervical spine was analyzed retrospectively. The standard treatment strategies were reevaluated. A total of nine patients (mean age 61 years, metastasis 4, plasmocytoma 3, chordoma 1, histiocytosis 1) were treated between 1/92 and 2/99. A total of 12 operations were carried out. One-step procedures (6): Three extraoral, one transoral, one dorsal and in one case combined dorsal and extraoral tumor removal were performed. Three dorsal occipitocervical or atlantoaxial stabilizations, one ventral plating and two combined ventral plating plus dorsal three-point fixations, and four vertebral body replacements were carried out. Two-step procedures (3): three extraoral tumor removals with ventral plating plus dorsal three-point fixation, in combination with vertebral body replacement in two cases. The neurological status and the quality of life (Karnofsky performance status, pain levels) were analyzed preoperatively and at the follow-up outpatient examinations (mean follow-up: 18 months). Flexion-extension radiographs were performed at the follow-up. There was no operative mortality. The transient morbidity was 11%. The operative intervention improved the quality of life in all patients. Three patients died within 27 months of operation. Tumor resection at the upper cervical spine using individually modified surgical strategies over an approach corresponding to the tumor location, stabilization and vertebral body replacement increases significantly the time of survival and quality of life with an acceptable surgical risk for complications.