En Bloc Resection of Malignant Cervical Spine Tumors With Consideration of Vertebral Artery Involvement

STUDY DESIGN: Retrospective collection of preoperative and postoperative data for a series of patients undergoing en bloc resection for malignant tumors in the cervical spine. OBJECTIVE: This study aims to share the long-term outcomes of en bloc resections for malignant cervical spine lesions-whether primary or solitary metastatic-from 2 centers, representing one of the largest multicenter series to date. SUMMARY OF BACKGROUND DATA: En bloc resection is the mainstay of treatment for resectable malignant vertebral tumors, offering optimal outcomes for disease control and survival. However, in the cervical region, this procedure is challenging due to the proximity of critical structures, especially the vertebral arteries (VAs). Preoperative vertebral angiography and an intraoperative arterial block test can help ensure contralateral VA patency, allowing for safe VA management and favorable outcomes with an acceptable complications risk. METHODS: Data were retrospectively recorded on patients who underwent total en bloc resection of malignant cervical spine lesions between 2005 and 2021. Each patient received a preoperative vertebral angiogram and intraoperative arterial block testing to confirm bilateral VA patency, allowing for the sacrifice of the affected VA when necessary. Details on the lesion characteristics, surgical approach used, oncological treatment, postoperative complications, and overall disease progression (recurrence or remission) were documented. RESULTS: Eleven patients were operated on and followed for a median of 13 years (range: 4-19). Three patients were treated using a single anterior approach, while 8 required a double approach. All patients achieved tumor-free margins, and all are currently disease-free. Four patients required reintervention due to disease recurrence (n=3) or VA bleeding (n=1). No patients have experienced long-term functional or neurological deficits from the procedure. CONCLUSION: Total en bloc resection of malignant cervical spine tumors, though technically challenging, is feasible and offers curative potential with manageable surgical risks. LEVEL OF EVIDENCE: Level IV-case series.