The aim of this study was to evaluate survival of metastatic bone disease of an upper extremity, and to identify the prognostic factors that influence survival. Patients with metastatic bone disease of an upper extremity between 2008 and 2015 were reviewed from the database of a tertiary university hospital. Of 102 patients, 48 males and 54 females with a median age of 61 (range, 28-82 years), the humerus (64.7%), clavicle (13.7%), and scapula (12.7%) were the common sites for bone metastasis of an upper extremity. Fifty-nine (57.8%) presented with pathologic fracture. No history of cancer was found in 76.5% of patients. The mean onset of metastatic bone disease after the first diagnosis of primary cancer was 4.74 ± 14.07 months (range, 0-84 months). Lung (31.4%) was the most common primary cancer followed by liver (14.7%), breast (12.7%), thyroid (7.8%), and renal (3.9%). Eighty-two cases (80.39%) died from the disease such that the median survival was 4.08 months (95% CI 2.57-6.17). The significant risk factors were the type of primary tumor (P < 0.001, HR = 4.44; 95% CI, 1.99-9.90) and ECOG performance status (P = 0.021, HR = 2.11, 95% CI 1.12-3.99). Patients with metastatic bone disease of an upper extremity have a limited life expectancy. The type of primary tumor and ECOG performance status were the important prognostic factors that influenced overall survival. Our data help in the management of patients, families, and doctors, so as to avoid over- or under-treatment.

Malpositioning of cervical screws risks neurovascular injury. A cervical screw fixation system can provide proper rigidity, alignment correction, and high rates of fusion afforded by high pullout biomechanical strength. The objective is to assess the dimensions and axis of the C3-C7 cervical pedicles. A 1-mm slice thickness computed tomography (CT) scan of the cervical spine of 30 patients (15 males, 15 females) were analyzed and reconstructed in three-dimensions using Mimics(®) 10.01 software. We measured pedicle axis length (PAL), pedicle and lateral mass length (PL-LM), pedicle length (PL), outer pedicle width (OPW), and pedicle transverse angle (PTA) from the axial image and outer pedicle height (OPH) and pedicle sagittal angle (PSA) from the sagittal image. The OPH and OPW at all subaxial cervical spines were suitable for insertion of 3.5 mm cervical pedicle screws. PSA was directed cranially at C3 to C5 (13.84, 7.09, and 2.71) and directed caudally at C6 and C7 (-4.55, -6.94). PTA was greatest at C5 and smallest at C7. The respective difference between the left and right side for nearly all parameters was not statistically significant (except for C6 PL and C7 OPH). Females had a significantly smaller OPH and OPW than males at nearly all levels. The PTA was not significantly different between the sexes. Cervical pedicle screw fixation in the Thai population can be safely performed and guidelines for insertion at each vertebra documented. Appropriate preoperative planning is necessary to achieve safe and accurate placement of the screws.