Surgical Techniques for Subaxial Cervical Spine Tumors (C3–C7)

STUDY DESIGN: Narrative review. OBJECTIVE: To provide an evidence-based review of surgical approaches to subaxial cervical spine tumors (C3-C7) emphasizing patient selection, technical pearls, and reported outcomes. SUMMARY OF BACKGROUND DATA: Cervical tumors encompass under 10% of spinal metastases yet carry disproportionate clinical significance due to highly mobile biomechanics and the surrounding structures. Primary tumors of the subaxial cervical spine present unique operative challenges that often require complex resection and reconstruction. METHODS: Current peer-reviewed literature regarding anterior, posterior, posterolateral, direct lateral, circumferential, and minimally invasive surgical approaches to subaxial cervical tumors was synthesized with recommendations for preoperative planning, tumor management, and reconstruction strategies. RESULTS AND CONCLUSIONS: The Smith-Robinson interval is the gold standard for direct access anterior procedures, including biopsy, en bloc resection, corpectomy, and anterior reconstruction. Posterior approaches address posterior-based tumors, intradural tumors, and resections requiring posterior release, with lateral mass and pedicle screw fixation tailored to individual anatomic features. The direct lateral approach addresses vertebra-adjacent and perineural lesions involving the transverse and neural foramina. En bloc spondylectomy is the standard for margin-negative resection of primary malignant cervical tumors. Advances in radio-chemotherapeutics, 3D-printed implants, robotic instrumentation, and minimally invasive surgery are expanding the treatment options within cervical spine oncology.