Occipitocervical Fusion Using Cervical Pedicle Screws for Metastatic Tumors to the Craniocervical Junction: Surgical Outcomes and the Role of Postoperative Chemotherapy

Advancements in chemotherapy have extended the survival of patients with metastatic cancer, increasing the need for effective treatment strategies for spinal metastases. Metastasis to the craniocervical junction significantly affects activities of daily living. This study evaluates the safety and effectiveness of cervical pedicle screws in occipitocervical fusion for metastasis to the craniocervical junction and reassesses the role of surgery within a multidisciplinary approach incorporating novel chemotherapy. A retrospective review was conducted on 21 patients with metastasis to the craniocervical junction who underwent occipitocervical fusion with cervical pedicle screws at Nagoya University Hospital and Aichi Cancer Center between November 2017 and August 2024. Clinical data, Eastern Cooperative Oncology Group Performance Status, imaging findings, surgical outcomes, perioperative complications, and adjuvant therapies were analyzed. The revised Tokuhashi score and the Modified Bauer score were used for prognostic assessment. All patients experienced significant postoperative pain relief, and 17 cases showed improvement in Eastern Cooperative Oncology Group Performance Status. Cervical pedicle screws provided rigid stabilization, allowing for limited fusion levels (fixation down to C3 in 11 cases). Seven of the 11 patients who received postoperative chemotherapy survived beyond their predicted prognosis. No intraoperative complications related to pedicle screws were reported. These findings suggest that occipitocervical fusion using cervical pedicle screws effectively stabilizes metastasis to the craniocervical junction while preserving limited fusion levels. A multidisciplinary approach integrating surgery and chemotherapy may improve survival in this challenging patient population.