Management of malignant atlanto-axial tumours

To review the management and outcomes of patients with malignant tumours of the atlanto-axial spine treated over a 4-year period at a tertiary hospital.

A total of 12 patients (9 female and 3 male) with a mean age of 56.5 years (range, 35-71 years) were consecutively enrolled. At the time of presentation, 7 patients had received treatment for a known primary malignancy of the lung (n=4), colon (n=1), nasopharynx (n=1), or breast (n=1). The atlanto-axial spine was the first presentation of malignant disease in the remaining 5 patients, whose subsequent diagnoses were multiple myeloma (n=1), carcinoma of the thyroid (n=1), malignant fibrous histiocytoma (n=2), and adenocarcinoma of unknown origin (n=1). Preoperative, postoperative, and follow-up radiographs and computed tomographic and magnetic resonance imaging scans were analysed with regard to the extent of tumour involvement, other spinal metastases, instability, and evidence of cord compression. Surgeries were performed for surgically fit patients with a life expectancy of more than 3 months.

All patients presented with severe suboccipital neck pain. Two had mild neurological deficits (Frankel grade D). Two patients were treated conservatively with rigid neck collars and survived for 3 and 11 months. Surgical stabilisation with posterior instrumentation was performed in 10 patients. One patient received additional anterior surgery for tumour debulking and bone grafting. No neurological complications were recorded in the series. Excellent relief of pain was achieved, and the mean visual analogue scale pain score of the operated patients improved from 9.3 to 1.9. The mean survival of 9 patients after surgery was 13.1 months, while one patient was still living at the time of review (at postoperative 11 months).

Surgical stabilisation in selected patients provided pain relief and preserved ambulatory status before the deterioration of overall function.