颈椎肿瘤学：围手术期管理与并发症

文献信息

中文摘要

研究设计： 叙述性综述。
目的： 综合关于原发性和转移性颈椎肿瘤手术围手术期并发症的当代证据，并为其预防和管理提供循证框架。
背景资料摘要： 颈椎肿瘤手术将密集的神经血管和呼吸消化道解剖结构与内科情况脆弱、常接受放疗的患者群体交汇在一起。尽管颈椎转移仅占脊柱转移性疾病的约8-20%，但其处理不当会带来不成比例的严重后果，从致残性疼痛到高位截瘫和死亡不等。目前缺乏颈椎特异性风险分层工具，且大多数现有证据是从退变性颈椎队列外推而来。
方法： 这是一篇关于颈椎肿瘤学围手术期并发症的叙述性综述。检索了PubMed/MEDLINE和Google Scholar截至2026年5月发表的英文文章，优先纳入过去5年的文献，同时在具有奠基性时纳入早期重要参考文献，检索词组合包括“cervical spine”“spinal metastasis”“spinal tumor”“perioperative complications”“airway”“vertebral artery”“wound”“dysphagia”“venous thromboembolism”和“hardware failure”。对纳入文章的参考文献列表进行手工检索以获取额外来源。研究由作者共识选择与所讨论并发症领域相关者；未进行正式偏倚风险评估和定量合并，符合叙述性设计。由于肿瘤学特异性证据有限，源自退变性颈椎队列的数据在全文均予以标明。
结果： 主要并发症领域包括气道受损（在多节段椎体次全切除、联合入路和颈胸段重建中最高）、血管和神经损伤、脑脊液漏、放疗野内的伤口失败和感染、内固定失败、静脉血栓栓塞症和吞咽困难。
结论： 结局取决于术前风险分层、多学科协调和个体化术后护理，而非任何单一术中操作。由于证据基础大多为III-IV级且缺乏经过验证的颈椎肿瘤学特异性工具，所述实践应被视为合理的、循证考虑的方案，而非诊疗标准。

英文摘要

STUDY DESIGN: Narrative review.
OBJECTIVE: To synthesize contemporary evidence on perioperative complications in primary and metastatic cervical spine tumor surgery and to provide an evidence-informed framework for their prevention and management.
SUMMARY OF BACKGROUND DATA: Cervical spine tumor surgery converges dense neurovascular and aerodigestive anatomy with a medically fragile, frequently irradiated patient population. Although cervical metastases represent only about 8-20% of spinal metastatic disease, their mismanagement carries disproportionately severe consequences, ranging from disabling pain to high-level paralysis and death. Cervical-specific risk-stratification tools are lacking, and most available evidence is extrapolated from degenerative anterior cervical cohorts.
METHODS: This is a narrative review of perioperative complications in cervical spine oncology. PubMed/MEDLINE and Google Scholar were searched for English-language articles published through May 2026, prioritizing literature from the past 5 years while including seminal earlier references where foundational, using combinations of the terms "cervical spine," "spinal metastasis," "spinal tumor," "perioperative complications," "airway," "vertebral artery," "wound," "dysphagia," "venous thromboembolism," and "hardware failure." Reference lists of included articles were hand-searched for additional sources. Studies were selected by author consensus for relevance to the complication domains discussed; formal risk-of-bias assessment and quantitative pooling were not performed, consistent with a narrative design. Because oncology-specific evidence is limited, data derived from degenerative cervical cohorts are identified as such throughout.
RESULTS: Major complication domains include airway compromise (highest with multilevel corpectomy, combined approaches, and cervicothoracic constructs), vascular and neurologic injury, CSF leak, wound failure and infection in irradiated fields, hardware failure, venous thromboembolism, and dysphagia.
CONCLUSIONS: Outcomes depend on preoperative risk stratification, multidisciplinary coordination, and individualized postoperative care rather than any single intraoperative maneuver. Because the evidence base remains largely Level III-IV without validated cervical oncology-specific tools, described practices should be regarded as reasonable, evidence-informed considerations rather than standards of care.