Anterolateral percutaneous vertebroplasty at C2 for lung cancer metastasis and upper cervical facet joint block.

Percutaneous vertebroplasty (PVP) of the axis (C2) is less aggressive than any surgical stabilizing procedure for the upper cervical spine, and it does not restrict the mobility of the upper cervical joints. Disruption of the weight-bearing unit of the second cervical (C2) vertebral body causes excessive load at the relatively small adjacent upper cervical joints. Upper cervical joint block before or after PVP at the C2 level has not been reported thus far. A 67-year-old man was referred to a pain clinic with a 6-month history of increasing neck pain without focal neurologic symptoms. Studies revealed a compression fracture of the C2 vertebral body and invasion of the adjacent soft tissue. To treat the mechanical component of the symptoms, anterolateral PVP at C2 was successfully performed, but the residual suboccipital headache was alleviated only after upper cervical joint block was performed. Thus, upper cervical joint block can be performed to treat the residual suboccipital headache after PVP at C2.