Surgical Approaches in Metastatic Disease Involving the Craniocervical Junction

The most common site for skeletal metastases is the spinal column, with the prevalence of metastatic disease far outweighing that of primary spinal tumors. Despite the increased prevalence of metastatic spine disease, metastases to the craniocervical junction (from the occiput to C2) are rare, representing only 0.5% of metastatic lesions. The craniocervical junction delineates the transition between the brain and spinal cord, and this highly mobile region is at increased risk for instability. The most common presentation of metastatic disease here is refractory mechanical neck pain that is rarely accompanied by neurologic deficits. The goals of treatment for metastatic spinal tumors of the craniocervical junction are palliative in nature, intended to relieve pain and to maximize function.