Percutaneous cement augmentation of a lytic lesion of C1 via posterolateral approach under CT guidance

BACKGROUND CONTEXT

Percutaneous vertebroplasty (PV) can provide pain relief and biomechanical stabilization of lytic metastasis of the spine in selected patients. Percutaneous vertebroplasty of the atlas has been reported in only five cases and has been performed with different techniques and approaches.

PURPOSE

To describe the technique we used to perform PV of a lytic lesion of the lateral mass of C1 under computed tomography, computed tomography angiography, and computed tomography fluoroscopy guidance with a posterolateral approach, sparing the vertebral artery (VA).

STUDY DESIGN/SETTING

Technical note.

METHODS

A 36-year-old woman with a history of intestinal carcinoid tumor presented with neck pain refractory to medical treatment. Radiological evaluation showed osteolytic destruction of the left lateral mass of the atlas, at the risk of collapse, with erosion of the VA canal. Under computed tomography and computed tomography angiography guidance, a percutaneous posterolateral oblique approach to the C1 left lateral mass was performed followed by cement augmentation under computed tomography fluoroscopy control.

RESULTS

Complete cement filling of the osteolytic lesion was achieved. A cement leak was noted along the horizontal V3 segment of the left VA. Computed tomography angiography scan showed patency of the VA after the procedure. There were no clinical complications. The patient reported substantial pain relief and improved range of motion at 12 hours postprocedure, which remained stable at 2-month follow-up examination.

CONCLUSIONS

Computed tomography-guided PV of C1 lytic lesion with posterolateral approach was effective in the described case for pain control and stabilization, and it may be a therapeutic option in selected patients to avoid occipitocervical fusion. This procedure requires good understanding of the anatomy and rigorous technique to avoid potential complications.

Kyphoplasty for lytic tumour lesions of the spine: prospective follow-up of 11 cases from procedure to death

BACKGROUND

The life span of cancer patients has improved due to advancements in cancer management. With long survival periods, more patients show metastatic disease. Osteolytic tumours of spine are generated by metastatic deposits or primary tumours of the spine. A prospective study was performed to evaluate the efficacy and safety of percutaneous kyphoplasty in patients with osteolytic tumours of the thoracic and lumbar spine.

MATERIALS AND METHODS

Eleven patients (age range 52-77/average 65 years; 7 female, 4 male) with osteolytic tumours of the spine were treated with kyphoplasty. The main Tokuhashi score was registered preoperatively. Outcome was assessed prospectively by visual analogue scale (VAS) for pain, ECOG performance status, walking distance, standing and sitting time.

RESULTS

Preoperative VAS (average 7.5; range 2.6-10) dropped to 3.0, 5 days postoperatively and remained below 5 for follow-up. Main Tokuhashi score was 6.3, ranging from 3 to 9. Survival time ranged from 2 to 293 (average 74.4) weeks. Average walking distance, standing and sitting time and ECOG performance score showed improvement. All patients returned home and no patient required re-operation or readmission due to local disease progression or recurrence.

CONCLUSION

Kyphoplasty is a suitable palliative treatment option for patients with advanced metastatic disease of the spine even with low Tokuhashi scores allowing rapid pain relief and mobilisation to increase the quality of life.

Percutaneous vertebral augmentation in metastatic disease: state of the art

Improvements in diagnosis and treatment have prolonged cancer survival, with a consequent increase in the incidence of spinal metastases and vertebral compression fractures with associated axial pain, progressive radiculomyelopathy, and mechanical instability. Pain relief in malignant vertebral compression fractures is key to achieving a better quality of life in patients under palliative care. The gold standard for pain relief is nonsteroidal anti-inflammatory drugs and opioids. Nonresponsive cases are then treated with radiotherapy, which may require 2-4 weeks to take effect and in most cases does not provide complete pain relief. Percutaneous vertebroplasty and percutaneous kyphoplasty can in particular give relief in patients with vertebral body compression fractures that do not cause neurological deficits but severely compromise quality of life because of intractable pain.

Pathological vertebral compression fracture of C3 due to a breast cancer metastasis in a male patient

STUDY DESIGN

A case of vertebral body fracture due to metastatic breast cancer in a male patient and a review of the literature are presented.

OBJECTIVE

To draw attention to the possible adverse skeletal events in breast cancer patients, and the need of a watchful staff within the multidisciplinary team in charge.

SUMMARY OF BACKGROUND DATA

Breast cancer is a rare condition in men, the male/female ratio is 1 of 100 approximately; in both sexes bone metastases are the most common. The pathologic fracture by spinal metastases can cause intense pain with difficult management. Vertebroplasty has been used successfully to treat pain and improve functional status in patients with vertebral compression fractures due to metastases.

METHODS

A 43-year-old male patient was diagnosed of having breast epithelial carcinoma after histologic analysis of a femur fracture. Following reconstruction, the patient started rehabilitative treatment. In a control visit, he referred sudden cervical pain which was initially treated with nonsteroidal anti-inflammatory drugs and rest. The patient was seen in a later visit and complained about poor response to analgesia. For this reason, a radiologic study was carried out, showing signs of fracture of the third cervical vertebral body (C3), and was completed with magnetic resonance imaging where the diagnosis of osteolytic metastasis was confirmed.

RESULTS

After consulting the interventionist radiology team, vertebroplasty was carried out aiming to diminishing the pain. There were no postoperative complications and the patient's recovery from cervicalgia permitted the nonsteroidal anti-inflammatory drugs suspension. Two weeks after the vertebroplasty, the patient resumed his rehabilitative treatment without presenting cervical pain or mobility limitation.

CONCLUSION

Spinal metastases treatment may include combinations of radiotherapy, vertebroplasty, and bisphosphonates, which have proved analgesic effect and a decrease of bone complications; however, out of these options, only vertebroplasty allows rapid stabilization and analgesia.