Percutaneous vertebroplasty for metastatic involvement of the axis

Percutaneous vertebroplasty in the upper cervical spine is a challenging procedure, and little is known about its therapeutic outcome. The purpose of this study was to assess the risks and benefits of percutaneous vertebroplasty for metastatic involvement of the axis.

From January 1994 to August 2004, 12 patients (mean age, 52.3 years) underwent percutaneous vertebroplasty via an anterolateral approach using fluoroscopic guidance for metastatic lesions involving the C2 vertebral body; pain intensity was scored on a scale ranging from 0.0 (no pain) to 10.0 (maximum pain intensity). Eight patients (66.7%) were followed up (mean, 6.9 months); 5 of them had percutaneous vertebroplasty indicated for pain control and spine stabilization and 3, for spine stabilization only.

The mean volume of cement injected was 2.9 +/- 0.7 mL (range, 2.0-4.0 mL) with a mean vertebral filling of 60.7 +/- 14.6% (range, 25-80%). Cement leakage was detected in 7 treated vertebrae (58.3%). Pain improvement was achieved in 4/5 patients (80%). Spine stability was observed in 7 patients (87.5%), but 1 patient (12.5%) presented with a secondary spine deformity in association with partial vertebral filling. Two postprocedural clinical manifestations (16.7%) were observed: 1 patient (8.3%) had a transient occipital neuralgia and another (8.3%) had an ischemic stroke. Mortality and morbidity rates at mean follow-up were 0.0% and 12.5% (1 patient), respectively.

Percutaneous vertebroplasty of C2 metastases by an antero-lateral approach is an effective option in the treatment strategy of patients with metastases to C2. Nevertheless, it is a challenging procedure and may carry regional and even intracranial risks due to the proximity to the vertebral artery.