Institute for Cancer Research and Treatment Candiolo, Turi, Italy.
Pain Physician. 2012 Jan-Feb;15(1):35-42.
Vertebroplasty is a minimally invasive procedure demonstrated to be safe and effective in the treatment of painful osteoporotic and malignancy related fractures when performed in the thoracolumbar spine. Multiple randomized and nonrandomized reports have demonstrated its effectiveness. Conversely, transoral vertebroplasty (TOV) to treat the second cervical vertebra (C2) has been described in only a few case reports.
Prospective evaluation of clinical results of TOV performed in malignant painful osteolytic lesions of C2.
TOV was performed in 25 consecutive patients suffering from high-grade cervical pain due to malignant involvement of C2 who failed conservative therapies and did not have surgical indications. Follow-up was prospectively evaluated with clinical interviews in all patients. The Internal Review Board approved this study.
Institute for Cancer Research and Treatment
Twenty-five patients (16 women and 9 men; mean age 59.3 ± 11.5) suffering from a painful malignant involvement of C2 who did not respond to conventional therapies and did not have surgical indications, underwent TOV for pain palliation. The procedure was performed under general anesthesia with combined digital fluoroscopy and computed tomography guidance. After a beveled vertebroplasty needle was manually advanced up to the posterior odontoid wall, bone cement was injected under continuous digital fluoroscopic control. Patients were discharged from the hospital the next procedural day. The Visual Analog Scale (VAS) for pain, analgesic requirement, and use of external cervical cast support were used for evaluating efficacy. The main end point was safety and efficacy at day 15 after the procedure. Furthermore, all the patients were scheduled to be followed-up at months one, 3, and 6, and every 6 months thereafter.
The median pretreatment VAS of 8 (range 5-10) significantly dropped (P < 0.0001) to 0 (range 0-10), with 20 patients (80%) achieving complete pain relief at day 15 after TOV. Differences in pre- and post-treatment analgesic therapy were significant (P < 0.001). Twenty-three patients no longer used a cervical cast after TOV (92%, P < 0.001). At median overall follow-up of 16 months (range 6-60 months), the projected proportion of patients free from worsening pain at 6, 12, and 24 months was 96%, 96% and 92% respectively.
A randomized study of only 25 patients.
TOV is safe, effective, and long-lasting in the treatment of cervical pain resulting from malignant involvement of C2.
椎体成形术是一种微创治疗方法，已被证明在治疗胸腰椎疼痛性骨质疏松性和恶性相关骨折时是安全有效的。多项随机和非随机报告已经证明了其有效性。相反，经口椎体成形术（TOV）治疗第二颈椎（C2）仅在少数病例报告中有所描述。
前瞻性评估 TOV 治疗 C2 恶性溶骨性病变疼痛的临床结果。
对 25 例因 C2 恶性累及而出现高颈痛且经保守治疗无效且无手术指征的患者行 TOV。所有患者均进行前瞻性临床访谈随访。内部审查委员会批准了这项研究。
癌症研究所和治疗中心
25 例（16 例女性和 9 例男性；平均年龄 59.3 ± 11.5 岁）因 C2 恶性累及而出现疼痛性恶性病变且对常规治疗无反应且无手术指征的患者，行 TOV 以缓解疼痛。在全身麻醉下，采用数字荧光透视和计算机断层扫描引导下进行操作。在手动将斜面椎体成形针推进至后齿状突壁后，在连续数字荧光透视控制下注入骨水泥。患者在术后次日出院。使用视觉模拟评分（VAS）评估疼痛、镇痛需求和使用外部颈托。主要终点是术后 15 天的安全性和疗效。此外，所有患者均在 1 个月、3 个月和 6 个月以及此后每 6 个月进行随访。
术前 VAS 的中位数为 8（范围 5-10），术后明显下降（P <0.0001）至 0（范围 0-10），20 例患者（80%）在 TOV 术后 15 天达到完全疼痛缓解。术前和术后镇痛治疗的差异有统计学意义（P <0.001）。23 例患者在 TOV 后不再使用颈托（92%，P <0.001）。在中位随访时间为 16 个月（范围 6-60 个月）时，预计在 6、12 和 24 个月时无疼痛恶化的患者比例分别为 96%、96%和 92%。
仅 25 例患者的随机研究。
TOV 治疗 C2 恶性累及引起的颈痛是安全、有效且持久的。
