Postoperative outcomes of subaxial cervical spine metastasis: Comparison among the anterior, posterior, and combined approaches

Panya Luksanapruksa; Borriwat Santipas; Panupol Rajinda; Theera Chueaboonchai; Korpphong Chituaarikul; Patawut Bovonratwet; Sirichai Wilartratsami

doi:10.1016/j.jbo.2022.100424

Postoperative outcomes of subaxial cervical spine metastasis: Comparison among the anterior, posterior, and combined approaches

J Bone Oncol. 2022 Mar 19:34:100424. doi: 10.1016/j.jbo.2022.100424. eCollection 2022 Jun.

Authors

Panya Luksanapruksa¹, Borriwat Santipas¹, Panupol Rajinda², Theera Chueaboonchai², Korpphong Chituaarikul¹, Patawut Bovonratwet³, Sirichai Wilartratsami¹

Affiliations

¹ Division of Spine Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
² Department of Orthopedic Surgery, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand.
³ Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.

Abstract

Background: The incidence of subaxial spinal metastases increases due to longer life expectancy resulting from successful modern cancer treatments. The three most utilized approaches for surgical treatment include the anterior, posterior, and combined approaches. However, despite increasing surgical volume, data on the postoperative complication profiles of different operative approaches for this patient population is scarce.

Methods: The institutional databases of two large referral centers in Thailand were retrospectively reviewed. Patients with subaxial cervical spine metastasis who underwent cervical surgery during 2005 to 2015 were identified and enrolled. Clinical presentations, baseline characteristics, operative approach, perioperative complications, and postoperative outcomes, including pain, neurological recovery, and survival, were compared among the three surgical approaches.

Results: The 70 patients (44 with anterior approach, 14 with posterior approach, 12 with combined approach) were enrolled. There were no statistically significant differences in preoperative characteristics, including Charlson Comorbidity Index (CCI), Tomita score, and Revised Tokuhashi score, among the three groups. There were no significant differences among groups for medical complications, surgical complications, neurological recovery, verbal pain score improvement, survival time, or ambulatory status improvement. However, the combined approach did show a significantly higher rate of overall perioperative complications (p = 0.01), intraoperative blood loss (p < 0.001), and operative time (p < 0.001) compared to the other two approaches.

Conclusions: Patients in the combined approach group had the highest rates of perioperative complications. However, although the differences were not statistically significant, patients in the combined group tended to have better clinical outcomes after follow-up and the longest survival time.

Keywords: Anterior approach; Combined approach; Posterior approach; Postoperative outcomes; Subaxial cervical spine metastasis; Thailand.