Surgical Outcomes of Occipitocervical Fusion for Metastatic Disease at the Craniocervical Junction: 25 Years of Experience at a Tertiary Cancer Referral Center
Neurosurgery Spine Oncology Fellow Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Texas 77030, USA Houston, Texas, United States
Introduction: Metastatic disease at the craniocervical junction is rare, often resulting in instability and pain, with limited data on treatment strategies. This study provides a 25-year retrospective review of occipitocervical fusion outcomes at a tertiary cancer center.
Methods: All adult patients who underwent occipitocervical fusion for metastatic disease at a single institution from 1999 to 2024 were identified from a prospectively maintained database. Non-metastatic cases were excluded. Preoperative data included demographics, Karnofsky Performance Status (KPS), epidural compression, prior radiation, and Visual Analog Scale (VAS) for pain. Pain outcomes were assessed by VAS, WHO Pain Ladder score, and Morphine Milligram Equivalents (MME) at immediate, 6-week, 3-month, and final follow-up. Complications were retrospectively reviewed from electronic medical records.
Results: A total of 135 occipitocervical fusions were identified; 76 were excluded for non-metastatic etiologies, leaving 59 patients eligible for analysis. The mean age was 60 ± 11 years. Median preoperative KPS was 80 (IQR 70–90), SINS was 11 (IQR 9–13), and renal cell carcinoma was the most common pathology (n=15, 25%). Lesions involved C1 or occipital condyle in 6 cases, C2 alone in 7, and both in 38 cases. Mean follow-up was 18 ± 26 months. Median preoperative VAS was 8 (IQR 5–10), with mean preoperative MME of 96.2 ± 117.2. Postoperative VAS was 4 at POD1, 4 at 6 weeks, 3 at 3 months, and 1 at last follow-up. In 48% of cases (n=27), decompression was performed with fusion. Complications occurred in 10% (n=6), with 5 wound healing issues, 3 of which required revision. One screw fracture did not require surgery. Median length of stay was 8 days (IQR 6–10).
Conclusion : Occipitocervical fusion is a safe, effective option for managing painful metastases at the craniocervical junction, showing an acceptable complication rate and significant pain relief. This series represents the largest reported on this condition.