Surgical treatment of upper cervical spine metastases: a retrospective study of 39 cases

Abstract

BackgroundThe surgical treatment of upper cervical spine metastases are controversial up to now. By summarizing and analyzing the clinical data of the upper cervical spine involved metastases treated surgically in our center, we mainly aimed to investigate the surgical decisions and outcomes so as to provide more references for the clinical treatment of this special and complex spine metastasis.MethodsWe evaluated the patients’ pre- and post-operative neck pain and neurologic function with paired t test, followed by the statistics of the selection of surgical approaches, ways of reconstruction, and related complications. Moreover, the Kaplan–Meier survival analysis was adopted to analyze the patients’ survival according to different growth group (rapid, moderate, and slow).ResultsThere were 39 patients with atlantoaxial metastases in this study. The most common symptom (94.87%) was occipital-cervical pain, which relieved greatly after surgical interventions (p < 0.01). The metastases mainly resulted from lung cancer and nasopharyngeal cancer with an incidence of 38.46 and 10.26%, respectively. As to different growth group, the rapid-growth tumors accounted for 69.23% in all atlantoaxial metastases. Tumor resection and stabilization were performed mainly via the combined anterior and posterior approach (66.67%). The 1-, 2-, and 3-year overall survival rate at the last follow-up was 58.5, 40, and 28.3%, respectively, with a median survival time of 18 months. The rate of complications associated with the surgical intervention was 12.82% (5/39), which is lower than that of the previous reports and generally controllable.ConclusionsRelatively radical interventions with surgery for upper cervical spine metastases offered satisfactory outcomes with a low mortality. Together with adjuvant therapy, surgical treatment benefits patients with atlantoaxial metastases by relieving regional pain, restoring or improving the neurologic function, stabilizing the quality of life, and prolonging the survival time of such patients.

Treatment of spine metastases in cancer: a review

“…4,5,[26][27][28][29] Currently, a multidisciplinary approach is the most common treatment strategy for spine metastases, which usually includes surgery, [29][30][31][32][33][34][35][36] radiotherapy, 15,[37][38][39][40][41][42][43][44][45][46][47][48] bone cement, 49,50 bisphosphonates 51 and chemotherapy. 51 Radiotherapy is an efficient therapeutic approach for symptomatic spine metastases patients that has a low morbidity rate. 41,[52][53][54][55][56] Surgery remains the standard treatment for patients with rapidly progressive spinal cord compression or patients with a high risk of fracture, but it can cause postoperative complications and delay the initiation of other anticancer therapies.…”

“…Longsegment percutaneous screw fixation could provide stability and improve quality of life in spine metastases patients who had early radiation therapy. Yang 2017 51 Surgery and chemotherapy Surgery for upper cervical spine metastases patients was an effective treatment with low mortality. Surgery combined with an adjuvant therapy could relieve the regional pain and enhance the neurological function, improve the quality of life and prolong the survival period in atlantoaxial metastases patients.…”

“…57 Indications for open surgery are severe pain or significant fracture with displacement, rapidly progressing neurological deficits, failure of conservative treatment, necessary pathological diagnosis, relatively long life expectancy and a relatively good general condition. 28,51 The surgical approaches and reconstructions that can be used are various and determination of which to use depends on the location of the tumour, the infiltration of the tumour, experience of the surgeons and general condition of the patients. 51 For reconstruction surgery, a new radiolucent system has been developed that can effectively restore the stability of the spine without causing any disturbance to CT, MRI and radiotherapy when compared with a traditional metal system.…”

Bone Metastases – Pathophysiology, Diagnostic Testing and Therapy (Part 2)

“…Alternatively, plate osteosynthesis is also possible and in 2016 Janssen et al showed that it is not the type of osteosynthesis performed in the region of the humerus diaphysis that primarily affects the outcome but rather tumour status based on the Bauer score [28]. Yang et al (2011) recorded a higher MST (MST: Musculoskeletal Tumor Society) score for intramedullary nailing than for prosthetic implant treatment [29]. In 2009, Gruber et al recommended intralesional curettage of metastases in a population in 19 patients with humeral metastases in combination with cement filling and intramedullary nailing and/or plate fixation due to the shorter surgery times, shorter hospital stays and fewer complications [30].…”

Metastatic hepatocellular carcinoma to the occipito‐cervical junction: a unique case and literature review

“…1 Metastatic involvement of the atlanto-occipital junction is rare 2 with only 16 cases previously reported ( Table 1). [3][4][5][6][7][8][9][10] Specifically, the most frequent primary tumour was lung cancer in six cases, following by thyroid cancer in three patients.…”