Both SRC and TAS produced excellent outcomes for atlantoaxial stabilization. But the volume of bleeding and operation time tended to be better in TAS group compared to SRC group.

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Background: Incidence of subaxial spinal metastases is increasing due to longer life expectancy resulting from successful modern treatments of cancer. The three most utilized approaches for surgical treatment include the anterior, posterior, and combined approach. 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: This study included 70 patients (44 anterior approach, 14 posterior approach, 12 combined approach). 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 also 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: The results of this study do not reveal any clear superiority among the three main surgical approaches used to treat subaxial cervical spine metastasis. 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.