The authors report a case of an upper cervical spine metastasis from a hepatocellular carcinoma at the C2 and C31evels, The patient, a 54 − year − old ma ! e , was admitted to hospital because of a severe lleck pain and a neck movement disturbance . X − rays of the cervical spine indicated erosi 〔 〕 n 〔 }f the C2 and C3 vertebral body and the arch , CT and MRI inspection revealed that the tumor was lnainly sited in the left posterolateral compartlnent of the axis and that it had invaded the

more »

... ural space of the spinal canal . Abdomillal CT showed multiple leg . ions in the liver . The serum level of α FP was 320 ng / ml and the PIVKA II was 7, 3 AU / ml . Based on these findings , the diagnosis was an upper cervical spine metastasis from a hepatocellular carcinoma . Prior to surgery , the primary lesioll in the liver was treated by a transarterial embolization using farmorubicin and gel foaln , The subsequent operation was performed by posterior deconlpression of the C2 and C3 region , followed by tumor removal and occipito . cervical stabjlization usjng Cotrel − Dubousset instrumentation ( CDI ) , After the surgery , the patient received radiotherapy totaling 60 Gy . The postoperative course proved uneventfu 】and the severe neck pains he had experienced were disappeared , although the radiculopathy of C5 and C61evel was temporalily found. Excellent and strong internal stabilization of CDI with posterior decompression permitted early improvement in activities of daily living and allowed for good palliative care , On the hook setting of CDI , the special care was needed to prevent the injury of spinal radicular nerves , (