Combined Ultrasound- and Fluoroscopy-guided Percutaneous Cementoplasty and Ablation for a C2 Pathologic Fracture: A...

Vertebral augmentation techniques are widely reported and effective for vertebral body fractures related to the thoracic and lumbar spine. However, techniques for accessing the cervical spine for vertebral augmentation purposes are limited. Historical approaches lack image guidance and/or involve open surgery. Our case involves a previously unreported, fully image-guided approach to the second cervical vertebra for ablation and vertebroplasty.

A 52-year-old male with a history of renal cell carcinoma presented with acute, intractable neck pain. Computed tomography of the cervical spine showed a destructive lytic lesion which resulted in a non-displaced type II dens fracture. Magnetic resonance imaging with contrast administration confirmed a marrow-replacing, enhancing lesion within the body of the axis vertebra. His pain was poorly controlled despite medical management, and he was unfit for surgery or radiation therapy. We used a percutaneous, anterolateral, and caudal-to-cranial approach to access his second cervical vertebra for cement augmentation and radiofrequency ablation of the lesion. The procedure was performed without complication, and the patient experienced significant pain relief.

This case demonstrates that metastatic lesions of the axis vertebra, including those extending into the dens, can be safely and effectively treated using a percutaneous, image-guided anterolateral approach combining ultrasound and fluoroscopy. This technique may offer a lower-risk alternative to previously described approaches for patients who are not surgical or radiation therapy candidates. This technique is directly relevant to clinicians experienced in vertebral augmentation, such as interventional radiologists and spine surgeons, and may also serve as a referral option for patients presenting with axis vertebra pain due to fracture and/or metastatic lesion.