Does the posterior-only approach provide adequate treatment for cervical spine metastases with severe vertebral body compromise?

Abstract

To assess posterior-only surgery for cervical spine metastases with severe vertebral compromise, characterized by severe compression fracture, ventral epidural compression, and extensive osteolytic destruction. We retrospectively analyzed 31 patients with C1-T1 metastases meeting severe compromise criteria: compression fracture with > 50% height collapse or local kyphosis, severe ventral compression with the epidural spinal cord compression scale > 1b, or extensive osteolytic destruction involving > 50% of the vertebral body. Comprehensive clinical assessments included pain severity (Numeric Rating Scale, NRS), neurological function (Frankel grading system), and performance status (Eastern Cooperative Oncology Group, ECOG). Radiographic evaluation focused on cervical sagittal alignment parameters. Survival analysis was performed using Kaplan-Meier methodology. Significant improvements were observed in pain (NRS: 6.1 ± 2.0 to 2.3 ± 1.2, P < 0.001), neurological function (90% of deficit patients improved ≥ 1 Frankel grade), and performance status (ECOG:3.1 ± 0.8 to 1.7 ± 0.9, P < 0.001). Cervical sagittal alignment was significantly restored in compression fracture cases. The surgical approach exhibited favorable stability with no instances of instrumentation failure during follow-up. Survival analysis indicated median overall survival of 11.0 months, with survival rates of 87.1%, 67.7%, and 48.4% at 3, 6, and 12 months postoperatively, respectively. The posterior-only surgical approach can effectively addresses severe vertebral body compromise in cervical metastases, providing durable pain relief, neurological preservation, and stability with acceptable morbidity. Future studies should develop evidence-based algorithms integrating tumor characteristics and patient factors to guide surgical decisions in metastatic cervical spine disease.