Miki Katzir1, Nguyen Hoang2, Eric Bourekas3, Ricardo Carrau4, Ehud Mendel2. 1. Department of Neurological Surgery, The Wexner Medical Center, James Cancer Center, The Ohio State University, 410 W 10th Ave, 1014 N Doan Hall, Columbus, OH, 43210-1267, USA. m.katzir1982@gmail.com. 2. Department of Neurological Surgery, The Wexner Medical Center, James Cancer Center, The Ohio State University, 410 W 10th Ave, 1014 N Doan Hall, Columbus, OH, 43210-1267, USA. 3. Department of Radiology, The Wexner Medical Center, James Cancer Center, The Ohio State University, Columbus, OH, USA. 4. Department of Otolaryngology, The Wexner Medical Center, James Cancer Center, The Ohio State University, Columbus, OH, USA.
Abstract
BACKGROUND: Metastatic cervical spine disease can cause compression fractures, cervical spine instability, and pain. Vertebroplasty can stabilize a fracture, reduce the pain associated with a compression fracture, prevent or stop the progression of a fracture, thus avoiding cervical spine fixation, and decreased mobility. Transoral C2 vertebroplasty is less invasive than open fusion surgery, but it poses its own risk of infection and cement leak in this highly sensitive area. METHODS: The image guidance setup consisted of the Stryker NAV3i navigation system, Stryker CranialMask tracker, and the CranialMap 3.0 software combined with biplanar fluoroscopy. RESULTS: The patient's neck pain has completely resolved immediately after the surgery. There were no complications. CONCLUSION: Quality of life preservation is paramount in the management of metastatic spine disease. Vertebroplasty of osteolytic lesions can both relieve pain and restore stability, thus avoiding permanent stiff cervical collar, halo vest, or upfront occipitocervical fusion. With the increasing availability of surgical navigation systems, its use combined with biplanar fluoroscopy for performing transoral C2 vertebroplasty seems to be an adequate treatment in selected cases for pain relief, stabilization, and maintaining quality of life in the complex cancer population with C2 pathological fractures. The article describes as well vertebroplasty of the subaxial spine through a conventional anterior approach which again seems to be adequate in the treatment of spinal pathological fractures. Graphical abstract.
BACKGROUND:Metastatic cervical spine disease can cause compression fractures, cervical spine instability, and pain. Vertebroplasty can stabilize a fracture, reduce the pain associated with a compression fracture, prevent or stop the progression of a fracture, thus avoiding cervical spine fixation, and decreased mobility. Transoral C2 vertebroplasty is less invasive than open fusion surgery, but it poses its own risk of infection and cement leak in this highly sensitive area. METHODS: The image guidance setup consisted of the Stryker NAV3i navigation system, Stryker CranialMask tracker, and the CranialMap 3.0 software combined with biplanar fluoroscopy. RESULTS: The patient's neck pain has completely resolved immediately after the surgery. There were no complications. CONCLUSION: Quality of life preservation is paramount in the management of metastatic spine disease. Vertebroplasty of osteolytic lesions can both relieve pain and restore stability, thus avoiding permanent stiff cervical collar, halo vest, or upfront occipitocervical fusion. With the increasing availability of surgical navigation systems, its use combined with biplanar fluoroscopy for performing transoral C2 vertebroplasty seems to be an adequate treatment in selected cases for pain relief, stabilization, and maintaining quality of life in the complex cancer population with C2 pathological fractures. The article describes as well vertebroplasty of the subaxial spine through a conventional anterior approach which again seems to be adequate in the treatment of spinal pathological fractures. Graphical abstract.