Metastatic lesions of the upper cervical spine.

Metastatic lesions of C1 and C2 most frequently present with severe pain and only rarely with neurologic involvement. The lesions are poorly visualized on plain roentgenogram and most often require bone scan and/or computed axial tomography (CAT) scan for definitive diagnosis. Delay in diagnosis in frequent in these patients (8 of 16). Radiation therapy and external mobilization yield satisfactory results for minor fractures or diffuse involvement without instability. Surgery is rarely indicated for decompression. However, in patients with C1 lateral mass involvement or severe C2 body destruction with instability, posterior stabilization gives excellent relief of pain. Onset after diagnosis of the primary tumor ranges from months to years. Survival is reasonable (mean, 9 months) after diagnosis of upper cervical spine involvement. Understanding these characteristics and the occurrence of metastatic disease in the upper cervical spine allows earlier diagnosis with appropriate radiographic studies and prompt palliation of symptoms.