En Bloc Resection for Primary Malignant Tumors of the Subaxial Cervical Spine

STUDY DESIGN: Case series and narrative review. OBJECTIVE: To provide a practical overview of the management of primary malignant bone tumors of the subaxial cervical spine, focusing on en bloc resection, and to propose a stepwise framework for surgical decision-making. SUMMARY OF BACKGROUND DATA: En bloc resection is generally considered the preferred treatment for selected primary cervical spine tumors as it offers the greatest potential for durable local control. However, subaxial cervical en bloc surgery remains technically demanding owing to complex regional anatomy, and the available literature is limited. METHODS: Four illustrative cases were combined with a narrative review of the literature. Surgical strategies were analyzed with emphasis on preoperative planning, anatomic and oncological considerations, technical challenges, and practical operative pearls. RESULTS: The illustrative cases and literature review demonstrated that successful subaxial cervical en bloc resection relies on careful assessment of tumor histology, compartmental extension, vertebral artery involvement, epidural disease, and relationships with the brachial plexus and visceral structures. Multistage circumferential approaches are frequently required to establish osteotomy planes, mobilize the specimen, and restore spinal stability. When en bloc resection is not technically feasible or would entail unacceptable morbidity, individualized strategies combining stabilization, neural decompression, and radiation therapy must be considered. CONCLUSIONS: En bloc resection is a complex strategy for selected cervical primary tumors, with the potential to provide durable long-term control. Larger prospective series are needed to better define outcomes and evaluate evolving reconstructive techniques and materials.