title: Anterior retropharyngeal approach to C1 for percutaneous vertebroplasty under C-arm fluoroscopy.
abstract: BACKGROUND
  Percutaneous vertebroplasty (PVP) has proven to be a valuable palliative treatment option for patients with medically refractory painful osteolytic metastases of the spine. Percutaneous vertebroplasty of the atlas has been reported in only seven articles and has been performed with different techniques and approaches.
  
  
  OBJECTIVE
  To describe the technique we used to perform PVP of a lytic lesion of the lateral mass of C1 via anterior retropharyngeal approach guided by C-arm fluoroscopy.
  
  
  METHODS
  A technical report.
  
  
  METHODS
  It included a 75-year-old man with known metastatic lung carcinoma and incapacitating right suboccipital and neck pain refractory to conventional medical treatment. Radiologic evaluation showed revealed osteolytic destruction of C1 and C2, mainly invading the right lateral mass of C1 and the vertebral body of C2.
  
  
  METHODS
  The right suboccipital and neck pain was measured using the visual analog scale (VAS).
  
  
  METHODS
  Under C-arm fluoroscopy, a novel anterior retropharyngeal approach, through the vertebral body of C2 into the metastatic osteolytic vertebral lesion of C1, was performed to achieve the PVP in C1 followed by a PVP in C2.
  
  
  RESULTS
  Immediately after the operation, the patient reported substantial pain relief (from VAS 9/10 preoperatively to 3/10). At 12 hours postoperatively, the range of motion was also improved. There were no surgery-related complications. The immediately postoperative cervical plain film and computed tomography scan showed adequate filling of the osteolytic lesion without the obvious leakage of bone cement. Clinical follow-up at 3 months revealed that this pain condition was improved and maintained (VAS 1/10).
  
  
  CONCLUSIONS
  When the transoral approach is unsuitable or contraindicated, the anterior retropharyngeal approach could be an efficacious alternative in selected patients with C1 metastasis, providing adequate filling of bone cement and significant pain relief. Based on our preliminary exploration, only assisted by C-arm fluoroscopy, this approach is feasible to achieve PVP in C1 under local anesthesia and intravenous analgesia. Nevertheless, when considering the substantial potential risks, this technically challenging procedure should be performed by experienced operators.
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China; Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
authors.forename: Jun-Song
authors.initials: JS
authors.lastname: Yang
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chu
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China.
authors.forename: Fu-Tao
authors.initials: FT
authors.lastname: Xiao
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China.
authors.forename: Dong-Jie
authors.initials: DJ
authors.lastname: Zhang
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China.
authors.forename: Zhen-Yong
authors.initials: ZY
authors.lastname: Ke
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
authors.forename: Ding-Jun
authors.initials: DJ
authors.lastname: Hao
authors.affiliation: Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China. Electronic address: zhongliang.deng@yahoo.com.
authors.forename: Zhong-Liang
authors.initials: ZL
authors.lastname: Deng
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D002484:Cementation; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000601:surgery*; D005471:Fluoroscopy; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D010014:Osteolysis; D010148:Intractable Pain / Q000209:etiology / Q000601:surgery; D010166:Palliative Care; D019904:Polymethyl Methacrylate / Q000008:administration & dosage; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Anterior; Atlas/C1; Fluoroscopy; Metastasis; Percutaneous; Retropharyngeal approach; Vertebroplasty