Mont'Alverne Francisco, Vallée Jean-Noel, Cormier Evelyne, Guillevin Remy, Barragan Hector, Jean Betty, Rose Michelle, Chiras Jacques
Department of Neuroradiology, Groupe Hospitalier Pitie-Salpetriere, Paris, France.
AJNR Am J Neuroradiol. 2005 Aug;26(7):1641-5.
Percutaneous vertebroplasty in the upper cervical spine is a challenging procedure, and little is known about its therapeutic outcome. The purpose of this study was to assess the risks and benefits of percutaneous vertebroplasty for metastatic involvement of the axis.
From January 1994 to August 2004, 12 patients (mean age, 52.3 years) underwent percutaneous vertebroplasty via an anterolateral approach using fluoroscopic guidance for metastatic lesions involving the C2 vertebral body; pain intensity was scored on a scale ranging from 0.0 (no pain) to 10.0 (maximum pain intensity). Eight patients (66.7%) were followed up (mean, 6.9 months); 5 of them had percutaneous vertebroplasty indicated for pain control and spine stabilization and 3, for spine stabilization only.
The mean volume of cement injected was 2.9 +/- 0.7 mL (range, 2.0-4.0 mL) with a mean vertebral filling of 60.7 +/- 14.6% (range, 25-80%). Cement leakage was detected in 7 treated vertebrae (58.3%). Pain improvement was achieved in 4/5 patients (80%). Spine stability was observed in 7 patients (87.5%), but 1 patient (12.5%) presented with a secondary spine deformity in association with partial vertebral filling. Two postprocedural clinical manifestations (16.7%) were observed: 1 patient (8.3%) had a transient occipital neuralgia and another (8.3%) had an ischemic stroke. Mortality and morbidity rates at mean follow-up were 0.0% and 12.5% (1 patient), respectively.
Percutaneous vertebroplasty of C2 metastases by an antero-lateral approach is an effective option in the treatment strategy of patients with metastases to C2. Nevertheless, it is a challenging procedure and may carry regional and even intracranial risks due to the proximity to the vertebral artery.
上颈椎经皮椎体成形术是一项具有挑战性的操作，对其治疗效果了解甚少。本研究旨在评估经皮椎体成形术治疗枢椎转移性病变的风险和益处。
1994年1月至2004年8月，12例患者（平均年龄52.3岁）经前外侧入路，在透视引导下对累及C2椎体的转移性病变行经皮椎体成形术；疼痛强度按0.0（无疼痛）至10.0（最大疼痛强度）评分。8例患者（66.7%）得到随访（平均6.9个月）；其中5例因疼痛控制和脊柱稳定而行经皮椎体成形术，3例仅为脊柱稳定而行该手术。
注入骨水泥的平均量为2.9±0.7 mL（范围2.0 - 4.0 mL），椎体平均填充率为60.7±14.6%（范围25 - 80%）。7个治疗椎体（58.3%）发现骨水泥渗漏。4/5患者（80%）疼痛改善。7例患者（87.5%）观察到脊柱稳定，但1例患者（12.5%）出现与部分椎体填充相关的继发性脊柱畸形。观察到2种术后临床表现（16.7%）：1例患者（8.3%）出现短暂性枕神经痛，另1例（8.3%）发生缺血性卒中。平均随访时死亡率和发病率分别为0.0%和12.5%（1例患者）。
经前外侧入路对C2转移瘤行经皮椎体成形术是C2转移患者治疗策略中的一种有效选择。然而，这是一项具有挑战性的操作，由于靠近椎动脉，可能存在局部甚至颅内风险。
