Tumours of the atlas and axis: a 37-year experience with diagnosis and management View Full Text


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Article Info

DATE

2011-11-17

AUTHORS

A. F. Mavrogenis, G. Guerra, M. Romantini, C. Romagnoli, R. Casadei, P. Ruggieri

ABSTRACT

PurposeThis paper presents a single institution’s longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options.Materials and methodsWe searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39.5 (range 5–77) years. For each patient, we collected data on clinical presentation, imaging and treatment. Mean follow-up was 10 years.ResultsBenign bone tumours were diagnosed in 24 (39%) and malignant tumours in 38 (61%) patients. The most common tumours were bone metastases, followed by osteoid osteomas and chordomas. The atlas was involved in six and the axis in 52 patients; in four patients, both the atlas and axis were involved. The most common clinical presentation was pain, torticollis, dysphagia and neurological deficits. Surgical treatment was performed in 35 patients and conservative treatment, including intralesional methylprednisolone injections and halo-vest immobilisation with or without radiation therapy, chemotherapy or embolisation, in the remaining patients. One patient with osteoblastoma of the atlas had local recurrence. All patients with metastatic bone disease had local recurrence; four of the eight patients with plasmacytoma progressed to multiple myeloma within 1–4 years. All patients with chordomas had two to four local recurrences. Patients with osteosarcomas and chondrosarcoma died owing to local and distant disease progression.ConclusionsBone tumours of the cervical spine are rare. However, they should be kept in mind when examining patients with neck pain or neurological symptoms at the extremities. In most cases, only intralesional surgery can be administered. Combined radiation therapy and chemotherapy is indicated for certain tumour histologies. More... »

PAGES

616-635

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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s11547-011-0753-y

    DOI

    http://dx.doi.org/10.1007/s11547-011-0753-y

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/22095422


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    42 schema:description PurposeThis paper presents a single institution’s longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options.Materials and methodsWe searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39.5 (range 5–77) years. For each patient, we collected data on clinical presentation, imaging and treatment. Mean follow-up was 10 years.ResultsBenign bone tumours were diagnosed in 24 (39%) and malignant tumours in 38 (61%) patients. The most common tumours were bone metastases, followed by osteoid osteomas and chordomas. The atlas was involved in six and the axis in 52 patients; in four patients, both the atlas and axis were involved. The most common clinical presentation was pain, torticollis, dysphagia and neurological deficits. Surgical treatment was performed in 35 patients and conservative treatment, including intralesional methylprednisolone injections and halo-vest immobilisation with or without radiation therapy, chemotherapy or embolisation, in the remaining patients. One patient with osteoblastoma of the atlas had local recurrence. All patients with metastatic bone disease had local recurrence; four of the eight patients with plasmacytoma progressed to multiple myeloma within 1–4 years. All patients with chordomas had two to four local recurrences. Patients with osteosarcomas and chondrosarcoma died owing to local and distant disease progression.ConclusionsBone tumours of the cervical spine are rare. However, they should be kept in mind when examining patients with neck pain or neurological symptoms at the extremities. In most cases, only intralesional surgery can be administered. Combined radiation therapy and chemotherapy is indicated for certain tumour histologies.
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    60 chemotherapy
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    63 clinical presentation
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    75 dysphagia
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    78 extremities
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    82 histology
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    84 immobilisation
    85 incidence
    86 injection
    87 intralesional methylprednisolone injection
    88 intralesional surgery
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    90 longterm experience
    91 malignant tumors
    92 management
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    94 materials
    95 mean age
    96 metastasis
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    98 methylprednisolone injection
    99 mind
    100 most cases
    101 multiple myeloma
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    103 neck pain
    104 neurological deficits
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    106 options
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    113 patients
    114 plasmacytoma
    115 presentation
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