Subaxial cervical, unstable, low ESCC

 

 

Patient not fit for surgery due to medical comorbidities or very advanced metastatic disease.

Nonoperative treatment consists of radiotherapy, and if needed, brace stabilization to prevent ranges of motion that cause pain.

 

 

Gross destruction of the vertebral bodies without posterior involvement

Contraindications

• Extensive neck treatment including radiation and prior surgery

Advantages

• Anterior column support
• Favorable wound healing

Disadvantages

• Risk of esophageal or vascular injury

 

 

Multilevel disease or circumferential tumors

Advantages

• Multilevel osseous fixation
• Possibility to extend fixation to the thoracic spine

Disadvantages

• Extensive paraspinal muscle dissection
• Need for a longer construct compared to stand alone anterior approach

 

 

Advantages

• Multilevel osseous fixation
• Possibility to extend fixation to the thoracic spine

Disadvantages

• Extensive paraspinal muscle dissection
• Need for a longer construct compared to stand alone anterior approach

 

 

Multilevel disease or circumferential tumors

Since most cases can be solved by either an anterior or posterior approach, the combined approach is only indicated in rare cases.

Advantages

• Multilevel osseous fixation

Disadvantages

• Extensive paraspinal muscle dissection
• Need for a longer construct compared to stand alone anterior approach
• Risk of esophageal or vascular injury
• Need for longer or multistage surgery