PubMed · 13921105
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R THUREL, J NEHLIL, P O'KEEFE. [Traumatic axoatloid dislocation].. https://pubmed.ncbi.nlm.nih.gov/13921105/
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Percutaneous vertebroplasty (PVP) of the axis is a challenging procedure which may be performed by a percutaneous or a transoral approach. There are few reports of PVP at the C2 level. We report a case of unstable C2 fracture treated with the percutaneous approach. The fracture was the first manifestation of multiple myeloma in a previously healthy 47-year-old woman. After local radiotherapy and chemotherapy, the fracture was still unstable and the patient had been continuously wearing a stiff cervical collar for 9 months. Complication-free PVP resulted in pain relief and stabilization and use of the cervical collar could be discontinued. At 18 months follow-up the patient remained free from pain, the fracture was stable and she had returned to work. The purpose of this article is to present the technical facts and to highlight the benefits and potential complications of the procedure. The technical characteristics of the procedure, the indication and results of the present case are discussed together with previously reported cases of PVP treatment at C2.
STUDY DESIGN: Case report. OBJECTIVE: This is one of the first reported cases of transoral vertebroplasty for a solid metastatic tumor at C2 body. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty has gained popularity as a treatment option for painful neoplastic lesions of the spine. The technique has been useful in reducing pain and stabilizing the spinal segment that is vulnerable to fracture. However, there is very little experience with vertebroplasty in the cervical spine and, more specifically, at C2. METHODS: We present a case of metastatic renal cell carcinoma of the C2 body. The patient, a 61-year-old woman, presented with an excruciating neck pain. Diagnostic workup revealed the presence of tumor in the right kidney. Multiple spinal levels were involved in addition to C2, and the C2 lesion was treated for palliative purpose. Under biplanar fluoroscopy, a vertebroplasty trocar was placed transorally into the central portion of the C2 body, and polymethyl methacrylate was injected. RESULTS: The transoral vertebroplasty achieved complete pain relief and enhanced stability of an extensive osteolytic lesion involving the C2 body. CONCLUSIONS: This minimal access procedure was effective in completely relieving pain from a metastatic deposit at C2, while adequately stabilizing the vulnerable segment by the injection of polymethyl methacrylate. The transoral route requires meticulous fluoroscopic control to prevent the leakage of polymethyl methacrylate but provides the most direct access to the C2 body.
OBJECTIVE: To study the relevant position of C(2) pedicle to C(2) inferior articular process, set up a technique of C(2) pedicle screw placement with the inferior articular process of axis as an anatomic landmark. METHODS: Fifty C(2) bone specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint and the lateral border of C(2) inferior articular process or C(2) pedicle; the width and the height of the C(2) pedicle were also evaluated. The anatomic relation between the measurements data of C(2) pedicle and that of C(2) inferior articular process were analyzed, and the technique of C(2) pedicle screw fixation was established. RESULTS: The medial border of C(2) inferior articular process was averaged (3.67 +/- 0.41) mm lateral to that of C(2) pedicle, and the midpoint C(2) inferior articular process was averaged (1.15 +/- 0.44) mm lateral to the lateral border of C(2) pedicle, respectively. Using the C(2) inferior articular process as landmark, two techniques was established for C(2) pedicle screw placement. The entry point of method A was located in 2 mm medial and superior to the central point of C(2) inferior articular process; the entry point of method B was at the crossing point of the medial border C(2) inferior articular process with the superior quarter of C(2) inferior articular process. CONCLUSIONS: There is a steady anatomic relation between C(2) pedicle and C(2) inferior articular process, the C(2) inferior articular process could be as a convenient key anatomic landmark to determine the location of C(2) pedicle and the position of C(2) pedicle screw entry point.