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Metastatic spinal tumors of the atlantoaxial region are quite uncommon thus surgical treatment is difficult and challenging procedure. The origin of these metastatic tumors are mainly breast, lung, and prostate neoplasms, or part of hematopoietic disorders such as myeloma multiplex, lymphoma. Clinical management of the C2 metastatic lesions includes open surgery, radiotherapy, vertebroplasty, and external immobilization. The aim of our study was to evaluate the safety and efficacy of simultaneous intraoperative transoral or transpedicular vertebroplasty combined with posterior fixation in case of C2 vertebral metastatic disease.Patients and Methods   We enrolled five patients with osteolytic C2 vertebral metastasis. The origin of the metastatic tumors was breast cancer in two cases, lung cancer in two cases, and multiple myeloma in one case. In three cases, we made purely posterior approach by dorsal open C2 biopsy and transpedicular vertebroplasty followed by posterior occipitocervical fixation. In the other two cases, patients underwent transoral C2 biopsy and vertebroplasty and dorsal occipitocervical fixation in the same session. The patients were followed with regular fluoroscopy, MRI, CT scans, and neurological examinations immediately after the operation and thereafter at 6 months. The HALO fixation device was removed after the first postoperative CT examination.Results   During our 8 to 19 months (average 13 months) follow-up period, we had no surgical or neurological complications with respect to this combined approach. The incidence of postoperative cervical pain was lower, compared with the preoperative pain. Preoperative VAS was 7 (6–8), while postoperative VAS was 3.5 (2–5). On postoperative neurological and radiological follow-up, no surgical or neurological complications developed with respect to this combined approach of the atlantoaxial region of the spine. The average volume of PMMA injected was 4 mL. We filled more than 60% of each patient's C2 vertebral body and dens.Conclusion   In this small series of simultaneous intraoperative transoral or transpedicular vertebroplasty and dorsal occipitocervical fixation proved to be a safe and effective treatment for patients with osteolytic C2 metastatic tumors. These techniques may provide excellent pain relief and improvements in quality of life. The true value of these combined techniques should be evaluated in larger series.

Treatment of C2 Vertebral Body and Dens Tumors with Intraoperative Transoral or Transpedicular Vertebroplasty and Occipitocervical Posterior Fixation