Vertebroplasty for Treatment of Osteolytic Metastases at C2 Using an Anterolateral Approach

Background: The clinical management of osteolytic metastases involving C2 is unique,because it is challenging to approach these lesions. Symptoms may vary from local pain toprogressive neurological deficit. Surgery or radiotherapy have been the treatments of choicefor several years; however, surgery may not be an option for patients with multiple metastasesand poor general medical status, and radiotherapy carries the risk of vertebral collapse andconsequent neural compression due to delayed bone reconstruction. Through differentapproaches, vertebroplasty has been introduced into clinical practice as an alternative totraditional surgical and radiotherapy treatments of osteolytic metastases at C2.Objective: This study aimed to evaluate the safety and efficacy of vertebroplasty with ananterolateral approach for osteolytic metastases at C2 under fluoroscopic guidance.Study Design: Vertebroplasty in 13 patients with osteolytic metastases at C2 and its clinicaleffects were evaluated.Setting: This study was conducted in an interventional therapy group at a medical center ina major Chinese city.Methods: Thirteen consecutive patients were treated with vertebroplasty via an anterolateralapproach. The researchers followed up with the patients for 3 to 12 months, with an averageof 9.2 months. The clinical effects were evaluated with the visual analog scale (VAS) preoperatively and at 3 days, one month, 3 months, 6 months, and 12 months post-operatively.Results: Thirteen consecutive patients were successfully treated with a satisfying resolutionof painful symptoms. Extraosseous cement leakages were found in 5 cases without any clinicalcomplications. VAS scores decreased from 7.6 ± 0.9 pre-operatively to 2.1 ± 1.9 by the 3-daypost-operative time point, and were 1.8 ± 1.7 at one month, 1.7 ± 1.8 at 3 months, 0.9 ± 0.8at 6 months, and 0.6 ± 0.5 at 12 months after the procedure. There was a significant differencebetween the mean pre-operative baseline score and the mean score at all of the post-operativefollow-up points (P < 0.001).Limitations: This was an observational study with a relatively small sample size.Conclusions: Vertebroplasty via an anterolateral approach is an effective technique to treatosteolytic metastases involving C2. It is a valuable, minimally invasive, and efficient method thatallows quick and lasting resolution of painful symptoms.Key words: Vertebroplasty, C2, anterolateral approach, osteolytic metastasis, pain