A modified anterolateral transdiscal percutaneous vertebroplasty with curved needle technique for C2/C3 metastases

Percutaneous vertebroplasty (PVP) for metastases in C2 or C3 vertebrae is limited due to technical challenges and severe adverse events. This study evaluates the efficacy and safety of a modified anterolateral transdiscal approach with curved needle technique for PVP of C2 or C3 metastases.

From January 2009 to December 2024, patients with metastatic tumors in C2 or C3 vertebrae, who underwent this modified PVP were included in a single-center clinical retrospective study. All patients underwent the procedure under biplane digital subtraction angiography (DSA) guidance with local anesthesia. The primary outcomes focused on pain reduction assessed using the visual analog scale (VAS), while secondary outcomes included cervical spine instability evaluated by the Spinal Instability Neoplastic Score (SINS). The incidence of cement leakage, reduction in analgesic usage, and changes in cervical collar usage rates at 6-month postprocedural were also monitored.

In total, 54 patients (mean age, 57 years ± 12, 28 men) were evaluated. Sixty-two cervical vertebrae were successfully punctured. Significant improvements in VAS and SINS were observed postprocedurally, indicating effective pain relief and cervical spine stability (p < 0.05). The mean volume of polymethylmethacrylate (PMMA) administered was 3.04 ± 0.77 mL. PMMA leakage was detected in 27 treated vertebrae (43.5%), but without severe adverse events. The patients demonstrated a notable reduction in analgesic consumption and decreased reliance on cervical collars.

This modified PVP using an anterolateral transdiscal approach with curved needle technique is a safe and effective treatment for metastatic tumors involving C2 or C3.

Question Can a modified anterolateral transdiscal approach with curved-needle navigation overcome technical barriers and safety concerns of conventional PVP for C2/C3 metastases? Finding The technique achieved 100% procedural success, significant pain reduction, and cervical spine stability (p < 0.05), 43.5% asymptomatic cement leakage, and reduced analgesic/collar dependency in 54 patients. Clinical relevance This modified anterolateral transdiscal approach with curved-needle PVP enables minimally invasive stabilization of high cervical metastases with a preserved safety profile, offering immediate pain control and cervical spine stability for patients ineligible for surgical intervention.