title: Transoral vertebroplasty for renal cell metastasis involving the axis: case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  This is one of the first reported cases of transoral vertebroplasty for a solid metastatic tumor at C2 body.
  
  
  BACKGROUND
  Percutaneous vertebroplasty has gained popularity as a treatment option for painful neoplastic lesions of the spine. The technique has been useful in reducing pain and stabilizing the spinal segment that is vulnerable to fracture. However, there is very little experience with vertebroplasty in the cervical spine and, more specifically, at C2.
  
  
  METHODS
  We present a case of metastatic renal cell carcinoma of the C2 body. The patient, a 61-year-old woman, presented with an excruciating neck pain. Diagnostic workup revealed the presence of tumor in the right kidney. Multiple spinal levels were involved in addition to C2, and the C2 lesion was treated for palliative purpose. Under biplanar fluoroscopy, a vertebroplasty trocar was placed transorally into the central portion of the C2 body, and polymethyl methacrylate was injected.
  
  
  RESULTS
  The transoral vertebroplasty achieved complete pain relief and enhanced stability of an extensive osteolytic lesion involving the C2 body.
  
  
  CONCLUSIONS
  This minimal access procedure was effective in completely relieving pain from a metastatic deposit at C2, while adequately stabilizing the vulnerable segment by the injection of polymethyl methacrylate. The transoral route requires meticulous fluoroscopic control to prevent the leakage of polymethyl methacrylate but provides the most direct access to the C2 body.
authors.affiliation: Department of Neurosurgery, University of South Florida, Tampa, FL 33606, USA. dsachs12@hotmail.com
authors.forename: Donald C
authors.initials: DC
authors.lastname: Sachs
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.forename: Ehud E
authors.initials: EE
authors.lastname: Mendel
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Guiot
mesh_terms: D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000473:pathology*; D001843:Bone Cements / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology / Q000517:prevention & control; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009055:Mouth; D019547:Neck Pain / Q000209:etiology; D009392:Nephrectomy; D010014:Osteolysis / Q000209:etiology / Q000628:therapy*; D010166:Palliative Care; D019904:Polymethyl Methacrylate / Q000008:administration & dosage* / Q000627:therapeutic use; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate