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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

A postoperative sagittal cervical spine CT shows the placement of occiput to C5 instrumentation. (Note that the metastatic NSCLC lesion at the C0-C1 joint was not resected during surgery and that the subsequent alleviation of pain in the patient was achieved through mechanical stabilization of the occipitocervical joint alone)
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Figure 0003: A postoperative sagittal cervical spine CT shows the placement of occiput to C5 instrumentation. (Note that the metastatic NSCLC lesion at the C0-C1 joint was not resected during surgery and that the subsequent alleviation of pain in the patient was achieved through mechanical stabilization of the occipitocervical joint alone)

Mentions: The patient underwent an occiput to C5 instrumented stabilization and fusion using an occipital plate connected to lateral mass screws at C3, C4, and C5 [Figures 2 and 3]. Demineralized bone matrix (Optium, DePuy, Johnson and Johnson), mixed with cancellous bone chips were placed over the arthrodesed lamina and joints. Postoperatively, she experienced substantial neck pain relief, and was discharged in stable neurologic condition. She remained independently ambulatory and resided with her family. At her most recent follow-up (12 months postoperatively), the patient exhibited a neck pain level of 2/10, demonstrating sustained pain relief. A lateral cervical spine X-ray revealed no evidence of hardware failure or kyphosis [Figure 4]. The patient succumbed to her metastatic disease 14 months postoperatively.


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)

A postoperative sagittal cervical spine CT shows the placement of occiput to C5 instrumentation. (Note that the metastatic NSCLC lesion at the C0-C1 joint was not resected during surgery and that the subsequent alleviation of pain in the patient was achieved through mechanical stabilization of the occipitocervical joint alone)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: A postoperative sagittal cervical spine CT shows the placement of occiput to C5 instrumentation. (Note that the metastatic NSCLC lesion at the C0-C1 joint was not resected during surgery and that the subsequent alleviation of pain in the patient was achieved through mechanical stabilization of the occipitocervical joint alone)
Mentions: The patient underwent an occiput to C5 instrumented stabilization and fusion using an occipital plate connected to lateral mass screws at C3, C4, and C5 [Figures 2 and 3]. Demineralized bone matrix (Optium, DePuy, Johnson and Johnson), mixed with cancellous bone chips were placed over the arthrodesed lamina and joints. Postoperatively, she experienced substantial neck pain relief, and was discharged in stable neurologic condition. She remained independently ambulatory and resided with her family. At her most recent follow-up (12 months postoperatively), the patient exhibited a neck pain level of 2/10, demonstrating sustained pain relief. A lateral cervical spine X-ray revealed no evidence of hardware failure or kyphosis [Figure 4]. The patient succumbed to her metastatic disease 14 months postoperatively.

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