C2/C3 pathologic fractures from polyostotic fibrous dysplasia of the cervical spine treated with percutaneous vertebroplasty.
We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of patients with severe fibrous dysplasia of the spine with multiple cervical lesions and C2-C3 pathologic fractures that may not be a good surgical candidate. Polyostotic fibrous dysplasia involvement of the cervical spine is rare. Review of literature indicates only few reported cases of surgical management with one case of mortality indicating increased risks associated with surgical intervention. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization for fibrous dysplasia has not been reported. A 35-year-old man with McCune-Albright syndrome and severe polyostotic fibrous dysplasia of C2 and C3 vertebrae presented with severe neck pain, radiculopathy, quadriparesis and myelopathy. The lesion had pathologic fractures, and there was an os odontoideum with cervical cord atrophy at the C1 level. After discussing need for aggressive surgical management and potential complications, we offered PVP due to surgical risks involved. PVP was performed with a posterolateral transpedicular approach without complication. The patient had remarkable improvement in clinical relief of neck pain and improvement of myelopathic symptoms at 1-year follow-up. We present a case that illustrates a potential use of PVP in the management of a patient with symptomatic spinal fibrous dysplasia with associated pathologic fractures who was poor surgical candidate.
Dang
David
D
Department of Radiology, Ohio State University, Columbus, OH, USA.
Baig
Mirza N
MN
Christoforidis
Greg
G
Chiocca
E Antonio
EA
Gabriel
Joshue
J
D000328:Adult; D001284:Atrophy / Q000209:etiology; D001843:Bone Cements / Q000627:therapeutic use*; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005359:Fibrous Dysplasia, Polyostotic / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019547:Neck Pain / Q000209:etiology; D011782:Quadriplegia / Q000209:etiology; D011843:Radiculopathy / Q000209:etiology; D035583:Rare Diseases; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000209:etiology; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements