Phillips E, Levine A M
Division of Orthopaedic Surgery, University of Maryland Hospital, Baltimore, MD 21201.
Spine (Phila Pa 1976). 1989 Oct;14(10):1071-7. doi: 10.1097/00007632-198910000-00008.
Metastatic lesions of C1 and C2 most frequently present with severe pain and only rarely with neurologic involvement. The lesions are poorly visualized on plain roentgenogram and most often require bone scan and/or computed axial tomography (CAT) scan for definitive diagnosis. Delay in diagnosis in frequent in these patients (8 of 16). Radiation therapy and external mobilization yield satisfactory results for minor fractures or diffuse involvement without instability. Surgery is rarely indicated for decompression. However, in patients with C1 lateral mass involvement or severe C2 body destruction with instability, posterior stabilization gives excellent relief of pain. Onset after diagnosis of the primary tumor ranges from months to years. Survival is reasonable (mean, 9 months) after diagnosis of upper cervical spine involvement. Understanding these characteristics and the occurrence of metastatic disease in the upper cervical spine allows earlier diagnosis with appropriate radiographic studies and prompt palliation of symptoms.
C1和C2的转移性病变最常表现为严重疼痛，很少伴有神经受累。在普通X线片上病变显示不佳，大多数情况下需要进行骨扫描和/或计算机断层扫描（CAT）以明确诊断。这些患者经常出现诊断延迟（16例中有8例）。对于轻度骨折或无不稳定的弥漫性受累，放射治疗和外部固定可产生满意的效果。很少需要手术减压。然而，对于C1侧块受累或C2椎体严重破坏并伴有不稳定的患者，后路稳定术能很好地缓解疼痛。原发肿瘤诊断后的发病时间从数月到数年不等。上颈椎受累诊断后的生存期尚可（平均9个月）。了解这些特征以及上颈椎转移性疾病的发生情况，有助于通过适当的影像学检查更早地诊断，并迅速缓解症状。
