Posterior nerve-sparing multilevel cervical corpectomy and reconstruction for metastatic cervical spine tumors: case report and literature review.

BACKGROUND: Cervical spine metastases with circumferential spinal cord compression are often treated with combined anterior-posterior decompression and stabilization. In patients with large anterior neck masses, prior radiotherapy to the neck, or prior anterior neck surgery, however, anterior approaches may pose additional risk. In such cases, posterior-only approaches that allow for circumferential decompression and anterior column reconstruction may be beneficial.

CASE DESCRIPTION: We present the case of a seventy-year-old male with follicular thyroid carcinoma metastatic to the cervical spine causing spinal cord compression. We utilized a posterior-only approach for a C6/7 partial corpectomy and posterior decompression and fusion from C2-T2. Our technique involved pre-operative embolization of the right vertebral artery to safely gain access to the ventral surface of the spinal cord and vertebral bodies. Anterior column support was provided by a chest tube/polymethylmethacrylate construct, allowing the implant to be placed within the anterior column from a posterior approach without nerve root sacrifice. The patient tolerated the procedure well. He had no post-operative neurologic deficits. Two months later he underwent a total thyroidectomy followed by stereotactic radiotherapy to the tumor bed (2700 cGy total, 3 fractions). At one-year follow-up he was active and without significant pain or focal neurologic deficits.

CONCLUSIONS: We propose a novel approach to ventral/circumferential cervical spine tumors that combines epidural decompression and cervical stabilization via a posterior-only approach. By using a chest tube/polymethylmethacrylate construct, anterior column support can be achieved through a posterior approach without nerve root sacrifice.