Clinical evaluation of Luque's segmental spinal instrumentation for upper cervical metastases

We reviewed clinical data from eight patients with upper cervical metastases who were treated with an occipitocervical fusion procedure using Luque's segmental spinal instrumentation with a fan-shaped rod. All patients had diffuse involvement of the entire anterior vertebral body, extreme instability at C1/2, and severe preoperative neck pain, but no neurological deficits. This procedure provided significant postoperative pain relief, with only one patient experiencing deterioration. The activities of daily living (ADL) levels of four patients improved; ADLs in four patients who were severely impaired were unchanged. Even though tissue destruction continued after surgery, this procedure prevented further deformity and instability. There were two major surgical complications: respiratory quadriplegia and hydro-cephalic coma. Great care must be taken to avoid these problems. Of the various instrumentation possibilities now available, we strongly advocate consideration of this particular stabilization procedure for upper cervical metastases to provide dying patients with an optimal quality of life during their final days.