Introduction: Surgical treatment of osteolytic, metastatic tumors of the C2 vertebral body and dens is difficult and challenging procedure. The aim of our retrospective study was to evaluate the safety and efficacy of simultaneous intraoperative transoral or transpedicular vertebroplasty of the C2 vertebra and posterior fixation.
Methods: Five patients with osteolytic C2 vertebral body and dens metastases were treated under general anesthesia. In three cases dorsal open C2 biopsy and transpedicular vertebroplasty and C0-C5 posterior occipito-cervical fixation was applied. Two patients underwent transoral C2 biopsy and vertebroplasty and dorsal occipito-cervical fixation at the same session. All of the procedures were done under the guidance of fluoroscopy. The cervical spine was immobilized in HALO-device all of the patients, during the surgical procedures and postoperatively until the first control CT examination. The patients were followed with regular fluoroscopy, MRI, CT scans and neurological examinations.
Results: The techniques used did not affect the neurological outcome. The average volume of PMMA injected was 4ml (2-5 ml).The average filling of body and dens of C2 vertebra was more than 60%. No leakage of cement in the spinal canal, or paravertebral region was detected except one case, when small amount of cement appeared in C1-2 joint with no clinical significance. The incidence of postoperative local pain was lower, within acceptable limits (VAS: 2 to 4). Average follow-up was 13 months (8-19m). Every cases we detected spinal stability and pain reduction.
Conclusions: Simultaneous intraoperative transoral or transpedicular vertebroplasty and dorsal occipito-cervical fixation is a safe and effective treatment for patients with osteolytic C2 tumors. The posterior approach and transpedicular vertebroplasty is recommended for patients with C2 vertebral body tumors. In contrast, the transoral approach appropriate for patients with C2 dens tumors, because of the dens is challenging to reach posteriorly, but the approach also suitable for C2 vertebral body treatment.
Patient Care: Safe and effective treatment of C2 metastatic tumors.
Learning Objectives: By the conclusion of this session, participants be able to identify an effective treatment of C2 osteolytic metastatic tumors.