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• Acute pain control with medications and pain management

• If asymptomatic or mildly symptomatic with neck pain/radiculopathy with small focus of tumor:

– Radiation treatment (radiation oncology consultation)

– Chemotherapy (medical oncology consultation)

– Kyphoplasty (to treat pain)

– Surgical instrumentation and fusion (if there is concern for deformity, instability, or cord compression)

• If symptomatic with cord compression and myelopathy with large tumor burden:

– Urgent surgical decompression and fusion over multiple segments with tumor resection if deemed suitable candidate for surgery; may be followed by radiation treatment after resection if considered necessary by the radiation oncologist

◦ The oncologist will need to determine overall prognosis, Karnofsky performance score, and extent of visceral disease

◦ If poor surgical candidate with poor life expectancy, medical management is recommended

◦ Surgery may be done anteriorly, posteriorly, or combined two-stage approach for added stabilization (see ▶Fig. 1.13)

– Preoperative embolization may be indicated for select vascular tumors to the spine such as renal cell cancer, thyroid cancer, breast cancer, etc. in order to decrease vascularity intraoperatively

Fig. 1.13 (a, b) Radiology revealed presence of lower cervical tumor in teenage girl who presented with symptoms of myelopathy. Tumor embolization, anterior corpectomy (C6) with tumor resection and reconstruction, and fusion (C4–C6) were performed. Improved alignment was achieved and the tumor was confirmed to be totally resected. (Source: Introduction and background. In: Cohen A, ed. Pediatric Neurosurgery: Tricks of the Trade. 1st ed. Thieme; 2015).