Wu Xinjie, Tan Mingsheng, Qi Yingna, Yi Ping, Yang Feng, Tang Xiangsheng, Hao Qingying
Department of Spinal Surgery, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
Graduate School of Peking Union Medical College, Beijing, 100730, People's Republic of China.
BMC Musculoskelet Disord. 2018 Jan 11;19(1):11. doi: 10.1186/s12891-018-1928-7.
Metastases to the upper cervical spine were rarely reported in the literature. However, metastases to this area may cause spinal instability and cord compression, which in turn can result in respiratory failure and neurological dysfunction. The present study investigated the efficacy and safety of posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty for this disease.
This was a retrospective study that included 10 patients with metastatic involvement of the axis from March 2002 to May 2014. All cases presented with occipitocervical pain: 5 patients with compressive myelopathy and 6 patients with radiculopathy. Japanese Orthopedic Association (JOA) scores and Visual Analogue Scale (VAS) were used to evaluate the improvement of neurological function and pain intensity, respectively.
All patients underwent posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty. The VAS scores and JOA scores both improved postoperatively, from 8.2 ± 0.4 to 2.3 ± 0.2 and from 10.1 ± 2.2 to 14.2 ± 2.9, respectively. Additionally, the improvement rate of JOA was 52.4 ± 1.8%. The mean overall survival was 12.8 months. The median survival time was 7 months. The 6-month and 12-month survival rates were 70% and 40%, respectively. The mean duration of operation was 182 min and blood loss was 450 mL. The mean volume of bone cement injected was 4.0 mL. The cement extravasation was observed in only 1 patient without clinical symptoms. One patient developed tumour recurrence and died 1 month later.
Posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty was a safe and valuable palliative method with relatively less invasion to treat metastatic involvement of the axis.
上颈椎转移瘤在文献中鲜有报道。然而，该区域的转移瘤可能导致脊柱不稳和脊髓受压，进而引发呼吸衰竭和神经功能障碍。本研究探讨了后路减压枕颈固定联合术中椎体成形术治疗该疾病的疗效及安全性。
本研究为回顾性研究，纳入了2002年3月至2014年5月间10例枢椎转移瘤患者。所有病例均有枕颈部疼痛：5例伴有脊髓压迫症，6例伴有神经根病。采用日本骨科协会（JOA）评分和视觉模拟量表（VAS）分别评估神经功能改善情况和疼痛强度。
所有患者均接受了后路减压枕颈固定联合术中椎体成形术。术后VAS评分和JOA评分均有改善，分别从8.2±0.4降至2.3±0.2，从10.1±2.2升至14.2±2.9。此外，JOA评分改善率为52.4±1.8%。平均总生存期为12.8个月。中位生存时间为7个月。6个月和12个月生存率分别为70%和40%。平均手术时间为182分钟，失血量为450毫升。骨水泥平均注入量为4.0毫升。仅1例患者出现骨水泥渗漏，但无临床症状。1例患者出现肿瘤复发，1个月后死亡。
后路减压枕颈固定联合术中椎体成形术是一种安全且有价值的姑息性治疗方法，对枢椎转移瘤的侵袭性相对较小。
