title: Treatment of C-2 metastatic tumors with intraoperative transoral or transpedicular vertebroplasty and occipitocervical posterior fixation.
abstract: OBJECTIVE
  Metastatic spinal tumors of the atlantoaxial region are quite uncommon, and surgery is challenging. The aim in this study was to evaluate the safety and efficacy of transoral or transpedicular vertebroplasty combined with posterior fixation in C-2 metastatic disease.
  
  
  METHODS
  The authors collected from a hospital database all cases of C-2 metastatic tumor treated in the period from January 2009 to December 2012. Cases with histologically confirmed metastatic disease were included, but those with epidural tumorous propagation and signs of spinal cord compression were excluded.
  
  
  RESULTS
  Five patients (3 females, 2 males) with osteolytic C-2 metastasis were eligible for this study. In 3 cases a purely posterior approach was taken to perform a dorsal open C-2 biopsy and transpedicular vertebroplasty followed by posterior occipitocervical fixation. In the other 2 cases a transoral C-2 biopsy and vertebroplasty were performed in combination with dorsal occipitocervical fixation during the same operative session. Patients were followed up with regular fluoroscopy, MRI, and CT studies as well as neurological examinations. During an average follow-up of 13 months (range 8-19 months), no surgical or neurological complications were associated with this combined approach. In all cases spinal stability and pain reduction were detected. The average pain score according to the visual analog scale was 3.5 after surgery (range 2-5); before surgery, the average score was 7 (range 6-8). The average volume of polymethylmethacrylate injected was 4 ml. The body and dens of the C-2 vertebra was filled more than 60% for each patient.
  
  
  CONCLUSIONS
  In this small series, simultaneous intraoperative transoral or transpedicular vertebroplasty and dorsal occipitocervical fixation proved to be a safe and effective treatment for patients with osteolytic C-2 metastatic tumors. These techniques may provide excellent pain relief and improvements in quality of life. The true value of these combined techniques should be evaluated in larger series.
authors.affiliation: Departments of 1 Spine Surgery and.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Papp
authors.forename: Miklós
authors.initials: M
authors.lastname: Marosfői
authors.forename: István
authors.initials: I
authors.lastname: Szikora
authors.forename: Péter
authors.initials: P
authors.lastname: Banczerowski
mesh_terms: D000328:Adult; D000368:Aged; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology*; D016208:Databases, Factual; D016267:External Fixators; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology; D009777:Occipital Bone / Q000601:surgery; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods*
keywords: C-2; PMMA = polymethylmethacrylate; VAS = visual analog scale; axis; cervical spine; metastatic tumor; occipitocervical fixation; transoral; transpedicular; vertebroplasty