CT guided percutaneous vertebroplasty of C2 osteolytic lesion: a case report and technical note

Vertebroplasty is a minimally invasive treatment option for osteolytic spinal lesions. It provides pain relief and stability with established good results. In this paper, we describe a new CT guided percutaneous vertebroplasty technique using a direct lateral approach between the carotid sheath and the vertebral artery, that can be safely performed under conscious sedation in an outpatient setting. We report the case of a patient presenting a lytic lesion of C2 treated using the CT guided percutaneous vertebroplasty under conscious sedation. Local anesthesia using approximately 10 mL of lidocaine 1% was delivered in the skin, soft tissues and to the periosteum of C2. With the patient in dorsal decubitus on the CT table, a bone biopsy needle was introduced laterally, through the parotid and between the carotid artery and vertebral artery. The entry point on C2 was right under the lateral mass of C1 and anterolaterally to the vertebral vascular foramen. The procedure was well tolerated by the patient. No neurological changes were noted per-operatively. No immediate or short-term complications were noted. Patient was observed on a stretcher for 2 hours with nursing supervision before being discharged home. Patient reported satisfactory pain control at 6-month follow-up. CT guided percutaneous vertebroplasty under conscious sedation can be safely performed in an outpatient setting.