Metastatic Disease of the Cervical Spine

  • Ashley R. Poynton
  • Mark H. Bilsky
  • Federico P. Girardi
  • Patrick J. Boland
  • Frank P. CammisaJr.
Part of the Current Clinical Oncology book series (CCO)


Metastatic spine tumors occur in 5 to 10% of all cancer patients (1, 2, 3, 4, 5, 6, 7, 8, 9). Cervical spine involvement is relatively uncommon, accounting for less than 10% of all spinal metastases (6,7,9,10). The most prevalent tumors are lung, breast, prostate, kidney, and thyroid (2,3,11, 12, 13). Most patients presenting with cervical spine tumors generally have extra-cervical and extra-spinal sites of disease at presentation (6). Radiation therapy, surgery, or a combination, are the primary treatment modalities for cervical spine tumors. Treatment decisions are based primarily on the segmental level of cervical spine involvement, radio-sensitivity of the tumor, presence of mechanical instability, and prior treatment.


Cervical Spine Vertebral Body Lateral Mass Spinal Metastasis Spine Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brihaye J, Ectors P, Lemort M, Va Houtte P. The management of spinal epidural metastases. Adv Tech Stand Neurosurg 1998;16:121–176.Google Scholar
  2. 2.
    Barron KD, Hirano A, Araki S. Experiences with metastatic neoplasms involving the spinal cord. Neurology 1959;9:91–106.PubMedGoogle Scholar
  3. 3.
    Constans J, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 1983;59:111–118.PubMedGoogle Scholar
  4. 4.
    Hammerberg K. Surgical treatment of metastatic spine disease. Spine 1992;17:1148–1153.PubMedCrossRefGoogle Scholar
  5. 5.
    Nottebaert M, vonHochsetter A, Exner G, Schreiber A. Metastatic carcinoma of the spine. Int Orthop 1987;11:345–348.PubMedCrossRefGoogle Scholar
  6. 6.
    Rao S, Babini K, Schildhauer T, Borges M. Metastatic malignancy of the cervical spine. A nonoperative history. Spine 1992;17:407–412.CrossRefGoogle Scholar
  7. 7.
    Schaberg J, Gainor B. A profile of metastatic carcinoma of the spine. Spine 1985;10:19–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Walsh GL, Gokaslan ZL, McCutcheon IE, et al. Anterior approaches to the thoracic spine in patients with cancer: indications and results. Ann Thorac Surg 1997;64:1611–1618.PubMedCrossRefGoogle Scholar
  9. 9.
    Kleinman W, Kiernan H, Michelsen W. Metastatic cancer of the spinal column. Clin Orthop 1978;126:166–173.Google Scholar
  10. 10.
    Perrin R, McBroom R, Perrin R. Metastatic tumors of the cervical spine. Clin Neurosurg 1991; 37:740–755.PubMedGoogle Scholar
  11. 11.
    Boland PJ, Lane JM. Sundaresan N. Metastatic disease of the spine. Clin Orthop 1982;169:95–102.PubMedGoogle Scholar
  12. 12.
    Sim F. Diagnosis and Management of Metastatic Bone Disease. A Multidisciplinary Approach. New York, NY: Raven; 1988.Google Scholar
  13. 13.
    Tolli T, Cammisa F, Lane J, Martin T. Metastatic disease of the spine. In: Wiesel S, Boden S, eds. Seminars in Spine Surgery. Vol 7. Philadelphia, PA: WB Saunders; 1995:277–287.Google Scholar
  14. 14.
    Bilsky MH, Lis E, Raizer J, Lee H, Boland P. The diagnosis and treatment of metastatic spinal tumor. Oncologist 1999;4:459–469.PubMedGoogle Scholar
  15. 15.
    Asdourian PL, Mardjetko S, Rauschning W, Johnsson H Jr, Hammerberg KW, DeWald RL. An evaluation of spinal deformity in metastatic breast cancer. J Spinal Disord 1990;3:119.PubMedCrossRefGoogle Scholar
  16. 16.
    Asdourian P. Metastatic disease of the spine. In Bridwell K (ed). The Textbook of Spinal Surgery. Ed 2. Philadelphia, PA: Lippincott-Raven Publishers; 1997:2007–2050.Google Scholar
  17. 17.
    Jenis GL, Dunn EJ, An HS. Metastatic disease of the cervical spine. A review. Clin Orthop 1999;359:89–103.PubMedCrossRefGoogle Scholar
  18. 18.
    Atanasiu J, Badatcheff F, Pidhorz L. Metastatic lesions of the cervical spine. Spine 1993;18:1279–1284.PubMedCrossRefGoogle Scholar
  19. 19.
    Jonsson B, Jonsson H Jr, Karlstrom G, Sjostrom L. Surgery of cervical spine metastases a retrospective study. Eur Spine J 1994;3:76–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Marchesi DG, Boos N, Aebi M. Surgical treatment of tumors of the cervical spine and first two thoracic vertebrae. J Spinal Disord 1993;6:489–496.PubMedGoogle Scholar
  21. 21.
    Matsui H, Tatezaki S, Tsuji H. Ceramic vertebral body replacement for metastatic spine tumors. J Spinal Disord 1994;7:248–254.PubMedGoogle Scholar
  22. 22.
    Solini A, Orsini G, Broggi S. Metal cementless prosthesis for vertebral body replacement of metastatic malignant disease of the cervical spine. J Spinal Disord 1989;2:254–262.PubMedCrossRefGoogle Scholar
  23. 23.
    Nakamura M, Toyama Y, Suzuki N, Fujimura Y. Metastases to the upper cervical spine. J Spinal Disord 1996;9:195–201.PubMedGoogle Scholar
  24. 24.
    Sjostrom L, Olerud S, Karlstrom G, Hamberg M, Jonsson H. Anterior stabilization of pathologic dens fractures. Acta Orthop Scand. 1990;61:391–393.PubMedCrossRefGoogle Scholar
  25. 25.
    Sundaresan N, Galicich JH, Lane JM, Greenberg HS. Treatment of odontoid fractures in cancer patients. J Neurosurg 1981;54:187–192.PubMedGoogle Scholar
  26. 26.
    Barron KD, Hirano A, Araki S, Terry RD. Experiences with metastatic neoplasms involving the spinal cord. Neurology 1959;9:91–106.PubMedGoogle Scholar
  27. 27.
    Sherk H, Nolan J, Mooar P. Treatment of tumors of the cervical spine. Clin Orthop 1988;233:163–167.PubMedGoogle Scholar
  28. 28.
    Chabot M, Herkowitz H. Spine tumors: patient evaluation. In:Weisel S, ed. Seminars in Spine Surgery. Vol 7. Philadelphia, PA: WB Saunders; 1995:260–268.Google Scholar
  29. 29.
    Silverberg E, Lubera J. Cancer statistics. 1988. Cancer 1998;381:5–22.Google Scholar
  30. 30.
    Wada E, Ohmura M, Yonenobu K. Intramedullary changes of the spinal cord in cervical spondylotic myelopathy. Spine 1995;20:2226–2232.PubMedCrossRefGoogle Scholar
  31. 31.
    Moulopoulos LA, Kumar AJ, Leeds N. A second look at unenhanced spinal magnetic resonance imaging of malignant leptomeningeal disease. Clin Imaging 1997;21:252–259.PubMedCrossRefGoogle Scholar
  32. 32.
    Avrahami E, Tadmor R, Kaplinsky N. The role of T2-weighted gradient echo in MRI demonstration of spinal multiple myeloma. Spine 1993;18:1812–1818.PubMedCrossRefGoogle Scholar
  33. 33.
    Frank JA, Ling A, Patronas NJ et al. Detection of malignant bone tumors: MR imaging vs scintigraphy. Am J Radiol 1990;155:1043–1048.Google Scholar
  34. 34.
    Dehdashti F, Siegal BA, Griffeth LK, et al. Benign versus malignant intraosseous lesions: discrimination by means of PET with 2-[F-18] Fluoro-2-Deoxy-D-Glucose. Radiology 1996;200:243–247.PubMedGoogle Scholar
  35. 35.
    Ferpos E, Palermos J, Tsionos K, et al. Effect of pamidronate administration on markers of bone turnover and activity in multiple myeloma. Eur J Haematol 2000;65:331–336.CrossRefGoogle Scholar
  36. 36.
    Hortobagyi GN, Theriault RL, Lipton A, et al. Long-term prevention of skeletal complications of metastatic breast carcinoma with pamidronate. J Clin Oncol 1998;16:2038–2044.PubMedGoogle Scholar
  37. 37.
    Lipton A, Theriault RL, Hortobagyi GN, et al. Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast cancer and osteolytic bone metastases: longterm follow-up of two randomized, placebo controlled trials. Cancer 2000;88:1082–1090.PubMedCrossRefGoogle Scholar
  38. 38.
    Theriault RL, Lipton A, Hortobagyi GN, et al. Pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial. J Clin Oncol 1999;17:846–895.PubMedGoogle Scholar
  39. 39.
    Bilsky MH, Shannon FJ, Sheppard S, Prabhu V, Boland PJ. Diagnosis and management of metastatic tumor to the atlanto-axial spine. Spine, (In Press).Google Scholar
  40. 40.
    Phillips E, Levine AM: Metastatic lesions of the upper cervical spine. Spine 1989;14:1071–1077.PubMedCrossRefGoogle Scholar
  41. 41.
    Piper JG, Menezes AH. Management strategies for tumors of the axis vertebra. J Neurosurg 1996;84:543–551.PubMedCrossRefGoogle Scholar
  42. 42.
    Sherk H, Snyder B. Posterior fusions of the upper cervical spine: indications, techniques and prognosis. Orthop Clin North Am 1978;9:1091–1099.PubMedGoogle Scholar
  43. 43.
    Fang H, Ong G. Direct anterior approach to the upper cervical spine. J Bone Joint Surg 1962;44A:1588–1604.Google Scholar
  44. 44.
    Hadley MN, Spetzler RF, Sonntag VKH. The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression. J Neurosurg 1972;36:16–23.Google Scholar
  45. 45.
    Menezes AH, Traynelis VC. Gantz BJ. Surgical approaches to the craniovertebral junction. Clin Neurosurg 1994;41:187–203.PubMedGoogle Scholar
  46. 46.
    McAfee P, Bohlman H, Riley L Jr, Robinson RA, Southwick WO, Nachlas NE. The anterior retropharyngeal approach to the upper part of the cervical spine. J Bone Joint Surg 1987;69:1371–1383.PubMedGoogle Scholar
  47. 47.
    Kostuik JP, Errico TJ, Gleason TF, Errico CC. Spinal stabilization of vertebral column tumors. Spine 1988;13:250–256.PubMedCrossRefGoogle Scholar
  48. 48.
    Robinson R, Riley L. Techniques of exposure and fusion of the cervical spine. Clin Orthop 1995;109:78–84.Google Scholar
  49. 49.
    Nazzaro JM, Arbit E, Burt M. “Trap door” exposure to the cervicothoracic junction. Technical notes. J Neurosurg 1994;80:338–341.PubMedGoogle Scholar
  50. 50.
    Darling GE, McBroom R, Perrin R. Modified anterior approach to the cervicothoracoc junction. Spine 1995;20:1519–1521.PubMedCrossRefGoogle Scholar
  51. 51.
    Bilsky MH, Boland P, Lis E, Raizer J, Healey JH. Single-stage posterolateral transpedicular approach for spondylectomy, epidural decompression and circumferential fusion of spinal metastases. Spine 2000;25:2240–2249.PubMedCrossRefGoogle Scholar
  52. 52.
    Dunn EJ. The role of methylmethacrylate in the stabilization and replacement of tumors of the cervical spine: a project of the Cervical Spine Research Society. Spine 1977;2:15–24.CrossRefGoogle Scholar
  53. 53.
    Rao S, Davis R. Cervical Spine Metastases. In: Clark C, ed. The Cervical Spine.The Cervical Spine Research Society. Philadelphia, PA: Lippincott-Raven; 1998:603–619.Google Scholar
  54. 54.
    Harrington K. The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease. J Bone Joint Surg 1981;63:36–46.PubMedGoogle Scholar
  55. 55.
    Siegal T, Tiqva P, Siegel T. Vertebral body resection for epidural compression by malignant tumors. Results of forty-seven consecutive procedures. J Bone Joint Surg 1985;67:375–382.PubMedGoogle Scholar
  56. 56.
    McAfee P, Bohlman H, Ducker T, Eismont F. Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases. J Bone Joint Surg 1986;65:1145–1157.Google Scholar
  57. 57.
    Clarke CR, Kegi KJ, Panjabi MM. Methylmethacrylate stabilization of the cervical spine. J Bone Joint surg 1984;66:40–46.Google Scholar
  58. 58.
    Aebi M, Zuber K, Marchesi D. Treatment of cervical spine injuries with anterior plating. Indications techniques and results. Spine 1991;16:S38–S45.PubMedCrossRefGoogle Scholar
  59. 59.
    Jonsson H, Cesarini K, Petren-Mallmin M, Raushning W. Locking screw-plate fixation of cervical spine fractures with and without ancillary posterior plating. Arch Orthop Trauma Surg 1991;111:1–12.PubMedCrossRefGoogle Scholar
  60. 60.
    Mann D, Bruner B, Keene J, Levin A. Anterior plating of unstable cervical spine fractures. Paraplegia 1990;28:564–572.PubMedGoogle Scholar
  61. 61.
    Hall D, Webb J. Anterior plate fixation in spine tumor surgery. Spine 1991;16:S80–S83.PubMedCrossRefGoogle Scholar
  62. 62.
    McAfee PC, Bohlman HH. One-stage anterior cervical decompression and posterior stabilization with arthrodesis. A study of twentyfour patients who had a traumatic or neoplastic lesion. J Bone Joint Surg 1989;71:78–88.PubMedGoogle Scholar
  63. 63.
    Perrin RG, McBroom RJ. Anterior versus posterior decompression for symptomatic spinal metastasis. Can J Neurol Sci 1987;14:75–80.PubMedGoogle Scholar
  64. 64.
    Vaccaro AR, Falatyn SP, Scuderi GJ, et al. Early failure of long segment anterior cervical plate fixation. J Spinal Disord 1998;11:410–415.PubMedGoogle Scholar
  65. 65.
    Bouchard J, Koka A, Bensauan M, Stevenson S, Emery S. Effect of irradiation on posterior spinal fusions. A rabbit model. Spine 1994;19:1836–1841.PubMedCrossRefGoogle Scholar
  66. 66.
    Emery S, Brazinski M, Koka A, Bensusan JS, Stevenson S. The biological and biomechanical effects of irradiation on anterior spinal bone grafts in a canine model. J Bone Joint Surg 1994;76:540–548.PubMedGoogle Scholar

Copyright information

© Humana Press, Inc., Totowa, NJ 2006

Authors and Affiliations

  • Ashley R. Poynton
    • 1
  • Mark H. Bilsky
    • 2
  • Federico P. Girardi
    • 3
  • Patrick J. Boland
    • 4
  • Frank P. CammisaJr.
    • 5
  1. 1.The Hospital for Special Surgery and Memorial Sloan-Kettering Cancer CenterNew York
  2. 2.Department of Surgery, Neurosurgery ServiceMemorial Sloan-Kettering Cancer CenterNew York
  3. 3.Orthopaedic Surgery, Spinal Surgical ServiceThe Hospital for Special SurgeryNew York
  4. 4.Department of SurgeryOrthopaedic Service, Memorial Sloan-Kettering Cancer CenterNew York
  5. 5.Spine Care Institute, Spinal Surgical Service, The Hospital for Special Surgery, Department of Clinical SurgeryWeill Medical College of Cornell UniversityNew York

Personalised recommendations