Posterior occiput-cervical fixation for metastasis to upper cervical spine

Abstract

Background: Metastasis to craniocervical area may result in instability manifesting as disabling pain, cranial nerve dysfunction, paralysis, or even death. Stabilization is required to prevent complications. Nonoperative treatment modalities are ineffective in providing stability and adequate pain relief. We present our experience of diagnosis, presentation, and surgical management for metastatic tumors to the upper cervical spine (UCS). Methods: Single-center single-surgeon database of consecutively operated posterior occiput-cervical fusion for metastasis to UCS was reviewed from 2007 to 2016. Demographics, clinical, and surgical data were collected through chart review. Pain scores based on Visual Analog Scale (VAS) and other radiological data were noted. Kaplan–Meier curve was used for survival analysis. Clinical outcomes and complications were recorded. Results: A total of 29 patients (17 females/12 males) had the mean age of 56.7 ± 13.5 (24–82). Predominant metastasis included from the breast in 9 (31.03%) cases, followed by renal in 5, melanoma in 4, and 3 each from lung and colon. Axis was involved in 24 cases (C2 body in 21, pedicle in 8 cases). Atlas was involved in 9 cases (lateral mass in 8 cases and arch in 3 cases) and occiput was involved in three cases. Average Spinal Instability Neoplastic Score was 10 ± 2.3 (7–14). Mild cord compression was seen in 7 cases. Fusion extended from occiput to C4 fusion ( n = 23), C5 ( n = 5), and C6 ( n = 1). Average blood loss was 364.8 ± 252.1 ml and operative time was 235 ± 51.9 min. Average length of stay was 7 ± 2.8 days (3–15). VAS improved from 8.3 ± 1.5 to 1 ± 1.1 ( P < 0.001). C2 angulation corrected from 2.1° ±5.3° (0°–17°) to 0.5° ±1.2° ( P = 0.045). Three patients each developed cardiopulmonary complications and deep infection. The average survival was 14.5 ± 15.1 (0.15–50) months. Conclusion: C2 body is the most common site of metastasis. Occiput-cervical fusion for unstable upper cervical metastasis offers a good palliative treatment for pain relief and improved quality of life.

Experience in surgical treatment of vertebral metastatic tumors of craniovertebral localization

“…Учитывая топографо-анатомические особенности краниовертебральной области, высокие риски развития нестабильности краниоспинальной зоны, сопровождающиеся выраженным болевым синдром при ее метастатическом поражении, применение технологии изолированной стабилизации позвоночника представляется наиболее щадящей в лечении данной категории больных. Это косвенно подтверждается и тем фактом, что большинство доступных публикаций по теме хирургического лечения метастатического поражения краниовертебральной области описывают именно эту технологию [3][4][5][6].…”

“…Таким образом фиксация позвоночника выходит на первый план в хирургии метастатических поражений краниовертебральной области. Наружные методы фиксации (воротник, Halo-аппарат) неудобны и способны при длительном применении вызывать различные осложнения в среднем у 40 % больных, не получено убедительных данных об их эффективности [3]. Предпочтительными являются методы внутренней фиксации.…”

“…: ОСД -окципитоспондилодез; ОСД + ВП -комбинация окципитоспондилодеза и вертеброплатики; ОСД+РВ -комбинация окципитоспондилодеза и резекции опухоли из ретрофарингеального/заднего доступа.South Russian Journal of Cancer 2023.Vol. 4,[3][4][5][6][7][8][9][10][11] Kit O. I., Zakondyrin D. E. , Rostorguev E. E., Rostorguev V. E., Maslov A. A.…”

Management of Atlantoaxial Instability Due to a Pathological Fracture of the Axis

“…Cervical braces and conservative management may be used in some cases of upper cervical spinal fractures. However, pain relief is often not adequate and complications may occur [13]. Studies have found cervical collar complication rates ranging from 0% to 44.4% and higher 30-day mortality rates for conservative management compared to operative intervention [14,15].…”

Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

“…C2 body is the most common site of metastasis. Occipito-cervical fusion for unstable upper cervical metastasis offers a good palliative treatment for pain relief and improved quality of life (84).…”