A Stepwise Posterolateral Approach for Computed Tomography Guided C2 (Axis) Transpedicular Biopsy: A Technical Note

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• Minimally invasive percutaneous CT-guided biopsies are standard for spinal lesions.
• CT-guided biopsy of the C2 vertebral body presents technical challenges due to anatomical complexity and proximity to critical structures.
• The posterolateral approach for C2 biopsy is less documented than other methods.

Observation:

• A 70-year-old female with neck pain was diagnosed with a C2 vertebral body lesion, suspected to be metastasis.
• Imaging revealed a lung lesion and a C2 vertebral metastasis.
• A CT-guided posterolateral biopsy of the C2 lesion was performed under local anesthesia.

Findings:

• The posterolateral biopsy successfully obtained tissue for diagnosis.
• Histopathology confirmed moderately differentiated adenocarcinoma metastasis from the lung to the C2 vertebra.
• The patient received chemotherapy and radiotherapy based on IHC and genomic studies.

Implications:

• The posterolateral approach offers a viable alternative for C2 vertebral body biopsies, especially when other routes are difficult.
• Detailed anatomical knowledge and a stepwise approach are crucial for safe and effective C2 interventions.
• This technique can improve diagnostic yield in challenging spinal oncology cases.