1. 2013;16;E427-E434Vertebroplasty for Treatment of Osteolytic Metastases at C2 Using an Anterolateral Approach
   Case Series
   Xun-Wei Liu, MD, Min Li, MD, Li-jun Wang, MD, Peng Jin, MD, and Gang Sun, MD, PhD.

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 to progressive neurological deficit. Surgery or radiotherapy have been the treatments of choice for several years; however, surgery may not bean option for patients with multiple metastases and poor general medical status, and radiotherapy carries the risk of vertebral collapse and consequent neural compression due to delayed bone reconstruction. Through different approaches, vertebroplasty has been introduced into clinical practice as an alternative to traditional surgical and radiotherapy treatments of osteolytic metastases at C2.

OBJECTIVE: This study aimed to evaluate the safety and efficacy of vertebroplasty with an anterolateral approach for osteolytic metastases at C2 under fluoroscopic guidance.

STUDY DESIGN: Vertebroplasty in 13 patients with osteolytic metastases at C2 and its clinical effects were evaluated.

SETTING: This study was conducted in an interventional therapy group at a medical center in a major Chinese city.

METHODS: Thirteen consecutive patients were treated with vertebroplasty via an anterolateral approach. The researchers followed up with the patients for 3 to 12 months, with an average of 9.2 months. The clinical effects were evaluated with the visual analog scale (VAS) pre-operatively 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 resolution of painful symptoms. Extraosseous cement leakages were found in 5 cases without any clinical complications. VAS scores decreased from 7.6 ± 0.9 pre-operatively to 2.1 ± 1.9 by the 3-day post-operative time point, and were 1.8 ± 1.7 at one month, 1.7 ± 1.8 at 3 months, 0.9 ± 0.8 at 6 months, and 0.6 ± 0.5 at 12 months after the procedure. There was a significant difference between the mean pre-operative baseline score and the mean score at all of the post-operative follow-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 treat osteolytic metastases involving C2. It is a valuable, minimally invasive, and efficient method that allows quick and lasting resolution of painful symptoms.