title: Stabilization of Tumor-Associated Craniovertebral Junction Instability: Indications, Operative Variables, and Outcomes.
abstract: BACKGROUND
  Whether primary or metastatic, tumors of the craniovertebral junction (CVJ) are rare and challenging.
  
  
  OBJECTIVE
  To examine the surgical indications, operative variables, and outcomes in patients with tumors of the CVJ undergoing occipitocervical (OC) stabilization.
  
  
  METHODS
  A single-institution, retrospective case series was performed from a prospectively maintained spine database. Patients with primary or metastatic tumors of the CVJ who underwent OC stabilization were identified. Out of 46 patients who underwent OC fusion, 39 were for tumor. Paired t -tests and Wilcoxon rank-sum tests were performed to assess for postoperative changes.
  
  
  RESULTS
  Ten patients (26%) harbored primary tumors, and the remaining 29 (74%) had metastatic disease. Of the metastatic patients, 14 had a neurological deficit, 10 had severe neck pain, and 5 were deemed mechanically unstable. Postoperative visual analog pain scores were significantly reduced at all 3 follow-up times ( P < .001, 95% confidence interval [CI; 3.2, 6.0]; P = .001, 95% CI [2.6, 7.7]; P = .020, 95% CI [0.6, 5.5]). The percentage of patients who were ambulatory and neurologically improved or intact remained stable postoperatively with no significant declines. There were 2 perioperative mortalities (5%), and 13 patients (33%) experienced a major complication.
  
  
  CONCLUSIONS
  In patients with primary or metastatic tumor of the CVJ, OC stabilization using a cervical screw-rod system affixed to a midline-keel buttress plate, with or without posterior decompression, is a reliable method for CVJ stabilization in the oncologic setting. Improvement in pain and preservation of neurological function was seen.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Department of Neurosurgery, Memorial Sloan-Ketter-ing?Cancer Center, New?York, New?York.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Kreines
authors.affiliation: Department of Neurosurgery, Memorial Sloan-Ketter-ing?Cancer Center, New?York, New?York.
authors.forename: Ann
authors.initials: A
authors.lastname: Powers
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, Mas-sachusetts.
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Iorgulescu
authors.affiliation: Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: James B
authors.initials: JB
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, Memorial Sloan-Ketter-ing Cancer Center, New York, New York.|Department of Neurological Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.affiliation: Department of Neurosurgery, Memorial Sloan-Ketter-ing Cancer Center, New York, New York.|Department of Neurological Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
mesh_terms: D016208:Databases, Factual; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D012888:Skull Neoplasms / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013125:Spinal Neoplasms / Q000601:surgery*; D013131:Spine / Q000601:surgery; D016896:Treatment Outcome
keywords: Craniovertebral junction; Occipitocervical fusion; Pathologic fracture; Spinal fusion; Spinal metastases; Spinal tumors