The Journal of Bone and Joint Surgery, Vol 68, Issue 4 483-494, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Primary neoplasms of the cervical spine. Diagnosis and treatment of twenty-three patients
HH Bohlman, BL Sachs, JR Carter, L Riley and RA Robinson
The records of twenty-three patients with a primary benign or malignant
osseous neoplasm of the cervical spine were reviewed in an attempt to
clarify the most appropriate diagnostic and treatment methods for such
tumors. Thirteen patients had a benign tumor and ten patients had a
malignant tumor. Nineteen patients had been followed for two to eighteen
years (average, six years), and four had died from the malignant disease
between one and five months after its discovery. In addition to surgery,
medical treatment in the ten patients with a malignant tumor included
radiation therapy in seven and chemotherapy in two. Surgical treatment
consisted of an anterior and posterior partial resection combined with an
arthrodesis in four patients; an anterior partial resection in three, two
with an arthrodesis; a posterior partial resection and an arthrodesis in
two; and a biopsy but no further treatment in one patient. The duration of
survival ranged from one to five months for four patients and from two to
three years for four, and was eight and sixteen years in two patients. Two
of the thirteen patients with a benign tumor received radiation therapy.
Surgical treatment included both an anterior and a posterior resection with
arthrodesis in four, an anterior resection in three (with arthrodesis in
two), a posterior resection in four (with arthrodesis in three), and a
biopsy without surgical resection in two. At follow-up, twelve patients
were pain-free and had a solid arthrodesis, although one had required a
repeat excision posteriorly. One patient with Gorham's disease (diffuse
hemangiomatosis) died. During the period of thirty years (1953 to 1983)
when these patients were seen, both the diagnostic methods available and
the surgical approaches used have changed. Our present opinion is that all
primary osseous lesions of the cervical spine should be carefully defined
by arteriography, tomography, bone-scanning, computed tomographic scanning,
and myelography in order to properly plan the surgical approach. Total
excision of suspect malignant lesions is not attempted, but a major
intralesional excision should be carried out to decompress neural and
vascular structures and to obtain a biopsy specimen, followed by an
arthrodesis to stabilize the spine. For both malignant and benign tumors,
an anterior resection should be performed if the tumor is located
anteriorly, and a posterior approach should be used if the tumor is
predominantly in the posterior vertebral elements. Both of these procedures
should be combined with an arthrodesis.(ABSTRACT TRUNCATED AT 400 WORDS)
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