Percutaneous cement augmentation of a lytic lesion of C1 via posterolateral approach under CT guidance.
BACKGROUND
Percutaneous vertebroplasty (PV) can provide pain relief and biomechanical stabilization of lytic metastasis of the spine in selected patients. Percutaneous vertebroplasty of the atlas has been reported in only five cases and has been performed with different techniques and approaches.


OBJECTIVE
To describe the technique we used to perform PV of a lytic lesion of the lateral mass of C1 under computed tomography, computed tomography angiography, and computed tomography fluoroscopy guidance with a posterolateral approach, sparing the vertebral artery (VA).


METHODS
Technical note.


METHODS
A 36-year-old woman with a history of intestinal carcinoid tumor presented with neck pain refractory to medical treatment. Radiological evaluation showed osteolytic destruction of the left lateral mass of the atlas, at the risk of collapse, with erosion of the VA canal. Under computed tomography and computed tomography angiography guidance, a percutaneous posterolateral oblique approach to the C1 left lateral mass was performed followed by cement augmentation under computed tomography fluoroscopy control.


RESULTS
Complete cement filling of the osteolytic lesion was achieved. A cement leak was noted along the horizontal V3 segment of the left VA. Computed tomography angiography scan showed patency of the VA after the procedure. There were no clinical complications. The patient reported substantial pain relief and improved range of motion at 12 hours postprocedure, which remained stable at 2-month follow-up examination.


CONCLUSIONS
Computed tomography-guided PV of C1 lytic lesion with posterolateral approach was effective in the described case for pain control and stabilization, and it may be a therapeutic option in selected patients to avoid occipitocervical fusion. This procedure requires good understanding of the anatomy and rigorous technique to avoid potential complications.
Department of Radiology, Medical University of South Carolina, 96 J. Lucas St, Charleston, SC 29425, USA. acianfoni@hotmail.com
Alessandro
A
Cianfoni
Daniela
D
Distefano
Steve H
SH
Chin
Abhay K
AK
Varma
Zoran
Z
Rumboldt
Giuseppe
G
Bonaldi
D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use; D002276:Carcinoid Tumor / Q000556:secondary / Q000601:surgery; D001270:Cervical Atlas / Q000601:surgery*; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology; D019637:Orthopedic Procedures / Q000379:methods*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements