Background: The clinical management of spinal hemangiomas and osteolytic metastases
involving the upper cervical spine (C1-C3) is challenging. Symptoms vary from simple vertebral
pain to progressive neurological deficits. Surgery and radiotherapy have been the treatment
options for years. Surgery, however, can result in complications, such as hemorrhage, and may
be counter-indicated when the treatment goal is primarily palliative due to multiple metastases,
an unfavorable prognosis and/or a poor performance state. On the other hand, radiotherapy
carries the risk of inducing secondary sarcomas or producing radionecrosis. Percutaneous
vertebroplasty (PVP) was recently introduced as an alternative for treating patients in whom
surgery and radiotherapy are counter-indicated. As of yet, there are few PVP case reports.
Objective: This study aimed to evaluate the safety and efficacy of PVP using a computed
tomography (CT)-guided translateral approach via the space between the carotid sheath and
vertebral artery for hemangiomas or metastatic lesions at C1-C3 under local anesthesia.
Study Design: CT-guided PVP was performed in 15 patients with hemangiomas or metastatic
lesions at C1-C3 and clinical outcomes were evaluated.
Setting: An interventional therapy group at a medical center in a major Chinese city.
Methods: Fifteen consecutive patients had a total of 15 cervical vertebral bodies treated
with CT-guided PVP via a translateral approach. The patients were followed up for a mean
postoperative period of 8.3 months (range, 1-40 months). Pain status was assessed using a
visual analog scale (VAS). The presence of complications was assessed preoperatively (baseline)
and at 24 hours, 2 weeks, and one, 3, 6, 12 and 24 months postoperatively, or until the patient
died or was lost to follow-up.
Results: Fifteen consecutive patients were successfully treated with CT-guided PVP via a
translateral approach. Their mean VAS score decreased from 7.7 ± 2.9 preoperatively to 1.4 ±
1.5 by the 24 hour postoperative time point, and was 1.2 ± 1.3 at 2 weeks, 1.2 ± 1.3 at one
month, 1.4 ± 1.3 at 3 months, 0.6 ± 0.9 at 6 months, 0.3 ± 0.5 at 12 months, and 0 at 24
months after the procedure. The mean VAS score at all of the postoperative time points differed
significantly from the preoperative baseline score (P < 0.05). No severe complications were
observed. Mild complications included 2 cases (13.3%) of asymptomatic cement leakage into
the epidural space, one case (6.67%) of anterior leakage from the vertebral body, and 2 cases
(13.3%) of paravertebral leakage.
Limitations: This was an observational study with a relatively small sample size.
Conclusions: The safety and efficacy of CT-guided PVP using a translateral approach via the
space between the carotid sheath and vertebral artery were demonstrated in patients with
hemangioma or metastasis in the upper cervical spine. CT-guided PVP via a translateral approach
should become a treatment option for such patients.
Key words: CT-guided percutaneous vertebroplasty, upper cervical spine, translateral
approach, hemangioma, osteolytic metastasis, pain
Surgical consideration in posterior C1-2 instrumentation in case of vertebral artery anomaly
