Rustagi Tarush, Mashaly Hazem, Mendel Ehud
Ohio State University Wexner Medical Center, Columbus, OH, USA.
Indian Spinal Injuries Centre, New Delhi, India.
J Craniovertebr Junction Spine. 2019 Apr-Jun;10(2):119-126. doi: 10.4103/jcvjs.JCVJS_29_19.
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).
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.
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 ( = 23), C5 ( = 5), and C6 ( = 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 ( < 0.001). C2 angulation corrected from 2.1° ±5.3° (0°-17°) to 0.5° ±1.2° ( = 0.045). Three patients each developed cardiopulmonary complications and deep infection. The average survival was 14.5 ± 15.1 (0.15-50) months.
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.
颅颈区域转移可能导致不稳定，表现为致残性疼痛、颅神经功能障碍、瘫痪甚至死亡。需要进行稳定手术以预防并发症。非手术治疗方法在提供稳定性和充分缓解疼痛方面无效。我们介绍我们对上颈椎（UCS）转移瘤的诊断、表现及手术治疗经验。
回顾2007年至2016年连续接受后路枕颈融合术治疗UCS转移瘤的单中心单术者数据库。通过病历审查收集人口统计学、临床和手术数据。记录基于视觉模拟量表（VAS）的疼痛评分及其他影像学数据。采用Kaplan-Meier曲线进行生存分析。记录临床结果和并发症。
共29例患者（17例女性/12例男性），平均年龄56.7±13.5岁（24 - 82岁）。主要转移瘤包括乳腺癌9例（31.03%），其次为肾癌5例，黑色素瘤4例，肺癌和结肠癌各3例。枢椎受累24例（C2椎体21例，椎弓根8例）。寰椎受累9例（侧块8例，弓3例），枕骨受累3例。平均脊柱不稳定肿瘤评分10±2.3（7 - 14）。7例出现轻度脊髓受压。融合范围从枕骨至C4融合（n = 23）、C5（n = 5）和C6（n = ）。平均失血量364.8±252.1 ml，手术时间235±51.9分钟。平均住院时间7±2.8天（3 - 15天）。VAS评分从8.3±1.5改善至1±1.1（P < 0.001）。C2角从2.1°±5.3°（0° - 17°）矫正至0.5°±1.2°（P = 0.045）。3例患者分别出现心肺并发症和深部感染。平均生存期14.5±15.1（0.15 - 50）个月。
C2椎体是最常见的转移部位。枕颈融合术治疗不稳定的上颈椎转移瘤为缓解疼痛和改善生活质量提供了良好的姑息治疗。
