Balloon kyphoplasty and additional anterior odontoid screw fixation for treatment of unstable osteolytic lesions of the vertebral body C2: a case series

Transoral balloon kyphoplasty in a myeloma patient with painful osseous destruction of the corpus vertebrae axis

Multiple myeloma is the most common primary malignant disease of the spine, which can lead to pathological fractures with consecutive instability and immobilizing pain, due to osseous destruction of individual vertebral bodies. The different surgical care is challenging, although good stabilization should be achieved if possible. The resulting blocking of micro-movements leads to pain minimization. However, this is a symptomatic therapy and does not address the primary disease. In the following, we report on successful transoral balloon kyphoplasty for the treatment of myeloma-related osteolysis with a pathological fracture of vertebral body C2, which led to a significant clinical improvement.

Percutaneous Image-Guided Anterior Screw Fixation of the Odontoid Process

PURPOSE

To describe the technique of percutaneous image-guided anterior screw fixation of the odontoid process in five patients using hydrodissection of the jugulo-carotid and pre-vertebral spaces.

METHODS AND MATERIALS

Between 03/2018 and 03/2020, five patients from two university hospitals underwent a percutaneous image-guided anterior screw fixation of the odontoid process for one pathological fracture, two impending fractures and two traumatic fractures of the dens. Technical success was defined as a satisfactory positioning of the screw in the odontoid. Detailed data with the number and type of needles required, the time to perform hydrodissection, the volume of fluid used, the time for bone access, the size and lengths of the screws used, technical success, complications, clinical outcomes and follow-up were retrospectively assessed.

RESULTS

Technical success was achieved in 100% (5/5 cases), with a mean volume of hydrodissection of 218 ± 8.4 mL (range 210-230). Mean total procedure time was 112 ± 34 min (range 70-160). The lengths of the screws ranged from 30 mm to 55 mm. Additional cementoplasty was performed in the three malignant cases. VAS scores dropped on a 10-point scale from mean 5.8 ± 2.2 pre-procedure to 0.8 ± 0.4 after the procedure. No major complication occurred.

CONCLUSION

Percutaneous image-guided anterior screw fixation of the odontoid process using hydrodissection of the jugulo-carotid and pre-vertebral spaces is technically feasible and seems safe.

Stent augmentation of an anterior odontoid screw for type 2 odontoid fracture-dislocation in the elderly population: Report of two cases and literature review

The fixation of type 2 odontoid fractures poses significant challenges in the elderly population due to coexistent osteoporosis and communition resulting in a high failure rate with conventional anterior screw fixation. Two elderly patients with unstable odontoid peg fractures and coexistent osteoporosis were treated with stentoplasty and anterior odontoid screw fixation. Additional anterior transarticular C1–2 screws were placed to address C1–2 instability. Both patients made an uneventful clinical recovery. One of the anterior C1–2 screws loosened due to the poor purchase in the osteoporotic bone in one patient. This did not affect the final outcome, and both the patients demonstrated maintained reduction and good alignment of odontoid peg after 2 years of follow-up. There was no intraoperative cement leak, pseudoarthrosis, or loss of reduction. Stentoplasty coupled with the anterior odontoid screw is a safe technique that can provide a biomechanically sound fixation of type 2 odontoid fractures in the presence of osteoporosis and significant communition.