Posterior Occiput-Cervical Fixation for Metastasis to Upper Cervical Spine
Tarush Rustagi, Hazem Mashally, Ehud Mendel
Introduction: The cranio-cervical junction (CCJ) is rarely involved with metastasis (0.5%) of these cases. The CCJ and upper cervical spine (UCS) have a complex and intricate anatomy involving numerous joints and ligaments that contribute to motion and stability.
Objective: To study posterior only operated cases of occipito-cervical fusion for metastasis to cranio-cervical or upper cervical spine. Assess surgical outcomes, complications and survival.
Methods: Single center database of consecutively operated posterior occiput-cervical fusion for metastasis to upper cervical spine was reviewed (2007 – 2016). Demographics, clinical and surgical data were collected through chart review. Pain scores based on Visual Analogue Scale and other radiological data were noted. Kaplan-Meier curve was used for survival analysis. Clinical outcomes and complications were recorded.
Results: 29 patients (17 females/ 12 males) had mean age of 56.7+/-13.5 (24-82). Predominant metastasis included from Breast in 9 (31.03%). Axis was involved in 24 cases (C2 body in 21). Atlas was involved in 9 cases (lateral mass in 8 cases, arch in 3) and Occiput in three cases. Average SINS score was 10±2.3 (7-14). 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 minutes. 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 degrees (0-17 degrees) to 0.5±1.2 degrees (P=0.045). Average survival was 14.5±15.1.
Conclusions: 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.