Stereotactic CT image guidance and biplanar fluoroscopy for transoral C2 vertebroplasty and direct anterolateral subaxia
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TECHNICAL NOTE - SPINE - OTHER
Stereotactic CT image guidance and biplanar fluoroscopy for transoral C2 vertebroplasty and direct anterolateral subaxial vertebroplasty: a surgical technique note on access to the axial and subaxial spine Miki Katzir 1
&
Nguyen Hoang 1 & Eric Bourekas 2 & Ricardo Carrau 3 & Ehud Mendel 1
Received: 9 April 2020 / Accepted: 8 June 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Metastatic cervical spine disease can cause compression fractures, cervical spine instability, and pain. Vertebroplasty can stabilize a fracture, reduce the pain associated with a compression fracture, prevent or stop the progression of a fracture, thus avoiding cervical spine fixation, and decreased mobility. Transoral C2 vertebroplasty is less invasive than open fusion surgery, but it poses its own risk of infection and cement leak in this highly sensitive area. Methods The image guidance setup consisted of the Stryker NAV3i navigation system, Stryker CranialMask tracker, and the CranialMap 3.0 software combined with biplanar fluoroscopy. Results The patient’s neck pain has completely resolved immediately after the surgery. There were no complications. Conclusion Quality of life preservation is paramount in the management of metastatic spine disease. Vertebroplasty of osteolytic lesions can both relieve pain and restore stability, thus avoiding permanent stiff cervical collar, halo vest, or upfront occipitocervical fusion. With the increasing availability of surgical navigation systems, its use combined with biplanar fluoroscopy for performing transoral C2 vertebroplasty seems to be an adequate treatment in selected cases for pain relief, stabilization, and maintaining quality of life in the complex cancer population with C2 pathological fractures. The article describes as well vertebroplasty of the subaxial spine through a conventional anterior approach which again seems to be adequate in the treatment of spinal pathological fractures.
Keywords C2 fracture . Transoral . Vertebroplasty . Spine metastases
Introduction Vertebroplasty was first described in 1987 by Galibert and Deramond to treat a C2 aggressive hemangioma. This approach This article is part of the Topical Collection on Spine - Other * Miki Katzir [email protected] 1
Department of Neurological Surgery, The Wexner Medical Center, James Cancer Center, The Ohio State University, 410 W 10th Ave, 1014 N Doan Hall, Columbus, OH 43210-1267, USA
2
Department of Radiology, The Wexner Medical Center, James Cancer Center, The Ohio State University, Columbus, OH, USA
3
Department of Otolaryngology, The Wexner Medical Center, James Cancer Center, The Ohio State University, Columbus, OH, USA
is warranted in the oncological patient population due to their poor clinical condition and their need for radio/chemotherapy [2, 3, 5–9]. Vertebroplasty for osteoporotic or cancer-related vertebral compression fractures can reduce the possibility of further pathological fractures, stabilize a fracture, and reduce pain
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