En Bloc Resection for Primary Malignant Tumors of the Subaxial Cervical Spine: Oncologic and Technical Considerations.
Alberto Benato, Rebecca Du, Hanna Kemeny et al.
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Case in brief
This article combines four illustrative cases with a narrative review to discuss management of primary malignant bone tumors in the subaxial cervical spine. It describes en bloc resection as a potential option for selected tumors, with planning informed by histology, tumor extension, vertebral artery involvement, epidural disease, and proximity to the brachial plexus and visceral structures. Resection may require multistage circumferential approaches to create osteotomy planes, remove the specimen, and restore stability. When en bloc surgery is infeasible or carries unacceptable morbidity, individualized alternatives include stabilization, neural decompression, and radiation therapy.
What made this case unusual
The technical challenge is specific to the subaxial cervical region: complex anatomy can make en bloc resection difficult, particularly when tumors involve or approach the vertebral artery, brachial plexus, epidural space, or visceral structures.
Diagnostic / clinical pearl
Assess tumor extent and its relationship to critical neural, vascular, and visceral structures before deciding whether en bloc resection is feasible; the operative strategy must balance oncologic goals against anticipated morbidity.
Why it matters
The authors note that larger prospective series are needed to clarify outcomes and assess evolving reconstructive techniques and materials.