Transoral C2 biopsy and vertebroplasty

Area of Science:

• Neurosurgery
• Spinal Surgery
• Interventional Radiology

Background:

• Pathologic fractures of the C2 vertebral body and odontoid process present surgical challenges.
• Direct odontoid screw fixation has limitations, necessitating alternative approaches.
• Transoral vertebroplasty/kyphoplasty for C2 fractures is infrequently reported, often using fluoroscopy or CT guidance.

Purpose of the Study:

• To report a case of fluoroscopically guided transoral vertebroplasty for a C2 pathologic fracture.
• To highlight unique aspects of the procedure, including dual punctures and advanced imaging.
• To evaluate the feasibility and outcomes of this minimally invasive technique.

Main Methods:

• A patient with a C2 vertebral body and odontoid process lytic lesion with pathologic fracture underwent the procedure.
• A fluoroscopically guided transoral approach was utilized for vertebroplasty.
• Computed tomography angiography (CTA) was performed preoperatively to assess vasculature.
• Rotational flat-panel CT was used post-procedure to evaluate cement placement.
• Two separate punctures were necessary for adequate fracture stabilization.

Main Results:

• Successful fluoroscopic-guided transoral vertebroplasty was achieved.
• Dual punctures allowed for adequate stabilization of the pathologic fracture.
• Preoperative CTA and postoperative rotational flat-panel CT provided valuable imaging insights.
• The procedure addressed the complex C2 fracture effectively.

Conclusions:

• Fluoroscopically guided transoral vertebroplasty is a viable option for C2 pathologic fractures, especially when direct fixation is limited.
• The use of dual punctures can enhance stabilization in complex cases.
• Advanced imaging techniques like CTA and rotational flat-panel CT are crucial for planning and assessing cement placement in this approach.