title: Percutaneous vertebroplasty for metastatic involvement of the axis.
abstract: OBJECTIVE
  Percutaneous vertebroplasty in the upper cervical spine is a challenging procedure, and little is known about its therapeutic outcome. The purpose of this study was to assess the risks and benefits of percutaneous vertebroplasty for metastatic involvement of the axis.
  
  
  METHODS
  From January 1994 to August 2004, 12 patients (mean age, 52.3 years) underwent percutaneous vertebroplasty via an anterolateral approach using fluoroscopic guidance for metastatic lesions involving the C2 vertebral body; pain intensity was scored on a scale ranging from 0.0 (no pain) to 10.0 (maximum pain intensity). Eight patients (66.7%) were followed up (mean, 6.9 months); 5 of them had percutaneous vertebroplasty indicated for pain control and spine stabilization and 3, for spine stabilization only.
  
  
  RESULTS
  The mean volume of cement injected was 2.9 +/- 0.7 mL (range, 2.0-4.0 mL) with a mean vertebral filling of 60.7 +/- 14.6% (range, 25-80%). Cement leakage was detected in 7 treated vertebrae (58.3%). Pain improvement was achieved in 4/5 patients (80%). Spine stability was observed in 7 patients (87.5%), but 1 patient (12.5%) presented with a secondary spine deformity in association with partial vertebral filling. Two postprocedural clinical manifestations (16.7%) were observed: 1 patient (8.3%) had a transient occipital neuralgia and another (8.3%) had an ischemic stroke. Mortality and morbidity rates at mean follow-up were 0.0% and 12.5% (1 patient), respectively.
  
  
  CONCLUSIONS
  Percutaneous vertebroplasty of C2 metastases by an antero-lateral approach is an effective option in the treatment strategy of patients with metastases to C2. Nevertheless, it is a challenging procedure and may carry regional and even intracranial risks due to the proximity to the vertebral artery.
authors.affiliation: Department of Neuroradiology, Groupe Hospitalier Pitie-Salpetriere, Paris, France.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mont'Alverne
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Vallée
authors.forename: Evelyne
authors.initials: E
authors.lastname: Cormier
authors.forename: Remy
authors.initials: R
authors.lastname: Guillevin
authors.forename: Hector
authors.initials: H
authors.lastname: Barragan
authors.forename: Betty
authors.initials: B
authors.lastname: Jean
authors.forename: Michelle
authors.initials: M
authors.lastname: Rose
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
mesh_terms: D000328:Adult; D000368:Aged; D001368:Axis, Cervical Vertebra; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D013125:Spinal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*; D013131:Spine / Q000503:physiopathology
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate