Table 1.

Clinical data of 39 atlantoaxil metastases treated surgically in this study

Case	Age/sex	Primary tumor	Growth	Symptom	Level	Operation			Complication	Adjuvant therapy		Frankel	Follow-up (mos)
						Approach	Resection	Reconstruction		Pre-operation	Post-operation		Survival status
1	55/F	Lung	Rapid	Pain	C1	HCA + P	Piecemeal	OPCF	None	C	R	E/E	5	Death
2	55/M	Lung	Rapid	Pain	C1–2	HCA + P	Piecemeal	OPCF	None	—	C	D/E	33	Death
3	65/M	Lung	Rapid	Pain	C2–3	HCA + P	Subtotal	OPCF	None	—	R	E/E	7	Death
4	51/M	Lung	Rapid	Pain	C1–3	P	Subtotal	OPCF	None	—	R + C	D/E	10	Death
5	70/M	Lung	Rapid	Pain	C1–2	HCA + P	Piecemeal	OPCF	None	R		E/E	13	Death
6	60/F	Lung	Rapid	Pain	C1	P	Piecemeal	OPCF	None	C	R	E/E	29	Alive
7	62/M	Lung	Rapid	Pain, dysphagia	C1	HCA + P	Piecemeal	OPCF	None	—	R + C	E/E	12	Death
8	46/M	Lung	Rapid	Pain	C2	HCA + P	Piecemeal	OPCF	Wound dehiscence dysphagia dysphonia	—	R + C	D/E	24	Death
9	42/M	Lung	Rapid	Pain	C2	HCA + P	Piecemeal	OPCF	None	C	R	E/E	18	Death
10	45/M	Lung	Rapid	Pain	C2	HCA + P	Piecemeal	OPCF	None	—	—	E/E	6	Death
11	60/F	Lung	Rapid	Pain	C2–3	HCA	Piecemeal	BCT	None	—		E/E	9	Death
12	62/F	Lung	Rapid	Pain	C2–3	P	Piecemeal	C1–4	None	—	C	E/E	19	Alive
13	50/M	Lung	Rapid	Pain	C2,4	P	Piecemeal	C2–4	None	C	R	E/E	6	Death
14	52/M	Lung	Rapid	Pain	C2–4	P	Piecemeal	C2–4	None	—	C	E/E	10	Alive
15	72/M	Lung	Rapid	Pain	C2	HCA + P	Piecemeal	BGT + C1–4	None	—		E/E	17	Alive
16	61/M	Nasopharyngeal	Rapid	Pain	C1	HCA + P	Piecemeal	OPCF	None	—	R	E/E	71	Death
17	56/M	Nasopharyngeal	Rapid	Pain	C1–2	P	Subtotal	OPCF	None	—	R	E/E	26	Death
18	63/M	Nasopharyngeal	Rapid	Pain	C1–3	P	Subtotal	OPCF	None	—		E/E	15	Alive
19	55/M	Nasopharyngeal	Rapid	None	C2	HCA + P	Piecemeal	OPCF	None	—	R	E/E	10	Death
20	27/M	Hepatic	Rapid	Pain	C2	HCA + P	Piecemeal	OPCF	None	—	R	E/E	36	Alive
21	64/F	Hepatic	Rapid	Pain	C2	HCA + P	Piecemeal	OPCF	None	—	R	E/E	39	Death
22	56/M	Hepatic	Rapid	Pain, dysphagia	C2	HCA + P	Piecemeal	OPCF	None	—	—	D/D	3	Death
23	54/F	Thyroid	Slow	Pain, numbness of the upper limbs	C2–4	P	Piecemeal	C1–5	None	—	R	E/E	78	Alive
24	70/M	Thyroid	Slow	Pain	C2	HCA + P	Piecemeal	BGT + OPCF	None	—		D/E	12	Death
25	45/F	Thyroid	Slow	Pain, dysphagia dysphonia	C1–2	HCA + P	Piecemeal	OPCF	None	—	R	E/E	60	Death
26	45/M	Renal	Moderate	Pain	C1	P	Piecemeal	OPCF	None	C	C	E/E	13	Death
27	58/M	Renal	Moderate	Pain	C1–2	HCA + P	Piecemeal	OPCF	None	R	R	E/E	18	Death
28	59/M	Renal	Moderate	Pain, numbness of the upper limbs	C1–4	P + HCAa	Subtotal	OPCF	None	R + C	R	E/E	6	Death
29	60/M	Osteosarcoma	Rapid	Weakness of the lower limbs	C2–4	P	Subtotal	C2–5	Hematoma, wound dehiscence	—	—	C/C	6	Death
30	8/M	Osteosarcoma	Rapid	Pain	C1–2	P	Subtotal	OPCF	None	C	—	E/E	4	Death
31	37/M	Osteosarcoma	Rapid	Pain, weakness of the upper limbs	C1–2	HCA + P	Piecemeal	OPCF	None	—	C	E/E	36	Death
32#	77/M	Prostatic	Slow	Pain	C2	HCA + P	Piecemeal	BCT + OPCF	Died of airway obstruction	—	—	D	0	Death
33	62/M	Prostatic	Slow	Pain	C1–2	P	Piecemeal	OPCF	None	—	R	D/E	22	Death
34	51/F	Breast	Slow	Pain	C1–2	HCA + P	Piecemeal	OPCF	Dysphagia, dysphonia	—	R	D/E	72	Death
35	49/F	Breast	Slow	Pain	C2–4	HCA + P	Piecemeal	BCT + C2–5	None	R + C	—	E/E	24	Alive
36	62/F	Basaloma	Slow	Pain	C2–3	HCA + P	Piecemeal	BGT + OPCF	None	—	R	E/E	10	Alive
37	80/M	Colon	Moderate	Pain	C1–2	HCA + P	Piecemeal	OPCF	Dyspnea	—		E/E	10	Death
38	69/M	Bladder	Rapid	Pain	C2–3	HCA + P	Piecemeal	BCT + OPCF	None	—	—	D/D	3	Death
39	30/M	Unknown	Rapid	Pain	C1–2	HCA + P	Piecemeal	OPCF	None	—	R + C	D/E	47	Death

HCA high anterior cervical approach, P posterior, OPCF occipitalcervical fusion, BCT bone cement and titanium, BGT bone graft and titanium, R radiotherapy, C chemotherapy

^#Patient died of airway obstruction after operation

^aThe posterior approach was conducted first