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Metastasis to the occipitocervical junction: A case report and review of the literature.

Xu R, Sciubba DM, Gokaslan ZL, Bydon A - Surg Neurol Int (2010)

Bottom Line: A drastic improvement in the presenting debilitating mechanical neck pain was noted following an occipitocervical fusion.Destruction of this joint can lead to significant neck pain secondary to instability.Spinal fusion may afford significant and rapid resolution of these symptoms, and should be considered in the management of patients-even those with end-stage oncologic disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland.

ABSTRACT

Background: The management of metastatic spinal disease is generally considered palliative, as the progression of systemic disease is likely to hinder survival. Although the occurrence of C1-C2 instability due to metastatic disease is not uncommon and thus treatment options have been well-defined, craniocervical instability due to lesions occurring at the junction of the occiput and atlas is more rare, and treatment for metastasis to this region is less well-defined.

Case description: We present a patient with non-small-cell lung cancer metastatic to the atlanto-occipital facet joint complex. A drastic improvement in the presenting debilitating mechanical neck pain was noted following an occipitocervical fusion. A literature review of published cases of metastases to the occipitocervical junction was conducted along with treatment options.

Conclusions: The atlanto-occipital facet joint is a rare site of metastatic disease. Destruction of this joint can lead to significant neck pain secondary to instability. Spinal fusion may afford significant and rapid resolution of these symptoms, and should be considered in the management of patients-even those with end-stage oncologic disease.

No MeSH data available.


Related in: MedlinePlus

Computed tomography (CT) and magnetic resonance imaging (MRI) of the atlanto-occipital junction. a. An axial CT image shows significant hypodense areas in the right occipitocervical junction, demonstrating extensive tumor infiltration. b. The coronal CT image again illustrates the scope of metastatic disease in both the right atlas and occipital condyle, with both being almost entirely consumed by the tumor. c. A sagittal view shows hypodense destructive lytic masses in both the occipital condyle and atlas. d. A T2-weighted MR image shows normal cerebral spinal fluid distribution with no evidence of spinal cord compression
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Figure 0001: Computed tomography (CT) and magnetic resonance imaging (MRI) of the atlanto-occipital junction. a. An axial CT image shows significant hypodense areas in the right occipitocervical junction, demonstrating extensive tumor infiltration. b. The coronal CT image again illustrates the scope of metastatic disease in both the right atlas and occipital condyle, with both being almost entirely consumed by the tumor. c. A sagittal view shows hypodense destructive lytic masses in both the occipital condyle and atlas. d. A T2-weighted MR image shows normal cerebral spinal fluid distribution with no evidence of spinal cord compression

Mentions: A 66-year-old female with a two-year history of NSCLC status post lobectomy, with metastasis to the right kidney, right femur and pelvis, presented with severe occipital headaches and debilitating neck pain. She was functionally independent, with a Karnofsky score of 90. She was neurologically intact except for a left homonymous hemionopsia due to an old posterior cerebral artery distribution infarct. Brain and cervical spine computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed an old right occipital stroke, right C1 lateral mass and occipital condyle destructive lytic lesions, and a fracture of the right atlanto-occipital joint [Figure 1a–c]. There was no evidence of spinal cord compression [Figure 1d]. She had difficulty sitting up or standing up due to severe axial neck pain. She was started on intravenous morphine and placed in a cervical collar, which improved her pain minimally. Due to the destruction of the joint evident on radiographic images and the partial relief of the pain after stabilizing her in a neck orthosis, it was thought that the patient would benefit from internal stabilization.


Metastasis to the occipitocervical junction: A case report and review of the literature.

Xu R, Sciubba DM, Gokaslan ZL, Bydon A - Surg Neurol Int (2010)

Computed tomography (CT) and magnetic resonance imaging (MRI) of the atlanto-occipital junction. a. An axial CT image shows significant hypodense areas in the right occipitocervical junction, demonstrating extensive tumor infiltration. b. The coronal CT image again illustrates the scope of metastatic disease in both the right atlas and occipital condyle, with both being almost entirely consumed by the tumor. c. A sagittal view shows hypodense destructive lytic masses in both the occipital condyle and atlas. d. A T2-weighted MR image shows normal cerebral spinal fluid distribution with no evidence of spinal cord compression
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908354&req=5

Figure 0001: Computed tomography (CT) and magnetic resonance imaging (MRI) of the atlanto-occipital junction. a. An axial CT image shows significant hypodense areas in the right occipitocervical junction, demonstrating extensive tumor infiltration. b. The coronal CT image again illustrates the scope of metastatic disease in both the right atlas and occipital condyle, with both being almost entirely consumed by the tumor. c. A sagittal view shows hypodense destructive lytic masses in both the occipital condyle and atlas. d. A T2-weighted MR image shows normal cerebral spinal fluid distribution with no evidence of spinal cord compression
Mentions: A 66-year-old female with a two-year history of NSCLC status post lobectomy, with metastasis to the right kidney, right femur and pelvis, presented with severe occipital headaches and debilitating neck pain. She was functionally independent, with a Karnofsky score of 90. She was neurologically intact except for a left homonymous hemionopsia due to an old posterior cerebral artery distribution infarct. Brain and cervical spine computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed an old right occipital stroke, right C1 lateral mass and occipital condyle destructive lytic lesions, and a fracture of the right atlanto-occipital joint [Figure 1a–c]. There was no evidence of spinal cord compression [Figure 1d]. She had difficulty sitting up or standing up due to severe axial neck pain. She was started on intravenous morphine and placed in a cervical collar, which improved her pain minimally. Due to the destruction of the joint evident on radiographic images and the partial relief of the pain after stabilizing her in a neck orthosis, it was thought that the patient would benefit from internal stabilization.

Bottom Line: A drastic improvement in the presenting debilitating mechanical neck pain was noted following an occipitocervical fusion.Destruction of this joint can lead to significant neck pain secondary to instability.Spinal fusion may afford significant and rapid resolution of these symptoms, and should be considered in the management of patients-even those with end-stage oncologic disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland.

ABSTRACT

Background: The management of metastatic spinal disease is generally considered palliative, as the progression of systemic disease is likely to hinder survival. Although the occurrence of C1-C2 instability due to metastatic disease is not uncommon and thus treatment options have been well-defined, craniocervical instability due to lesions occurring at the junction of the occiput and atlas is more rare, and treatment for metastasis to this region is less well-defined.

Case description: We present a patient with non-small-cell lung cancer metastatic to the atlanto-occipital facet joint complex. A drastic improvement in the presenting debilitating mechanical neck pain was noted following an occipitocervical fusion. A literature review of published cases of metastases to the occipitocervical junction was conducted along with treatment options.

Conclusions: The atlanto-occipital facet joint is a rare site of metastatic disease. Destruction of this joint can lead to significant neck pain secondary to instability. Spinal fusion may afford significant and rapid resolution of these symptoms, and should be considered in the management of patients-even those with end-stage oncologic disease.

No MeSH data available.


Related in: MedlinePlus