Yang Jun-Song, Chu Lei, Xiao Fu-Tao, Zhang Dong-Jie, Wang Yang, Chen Liang, Ke Zhen-Yong, Hao Ding-Jun, Deng Zhong-Liang
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.
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.
Spine J. 2015 Mar 1;15(3):539-45. doi: 10.1016/j.spinee.2014.12.014. Epub 2014 Dec 15.
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.
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.
A technical report.
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.
The right suboccipital and neck pain was measured using the visual analog scale (VAS).
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.
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).
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.
经皮椎体成形术（PVP）已被证明是脊柱溶骨性转移瘤引起的药物难治性疼痛患者的一种有价值的姑息治疗选择。寰椎经皮椎体成形术仅有7篇文献报道，且采用了不同的技术和方法。
描述我们在C形臂透视引导下，经咽后前路对C1侧块溶骨性病变进行PVP的技术。
技术报告。
包括一名75岁男性，已知患有转移性肺癌，右枕下和颈部疼痛严重，常规治疗无效。影像学评估显示C1和C2溶骨性破坏，主要侵犯C1右侧块和C2椎体。
采用视觉模拟量表（VAS）测量右枕下和颈部疼痛。
在C形臂透视下，采用一种新的经咽后前路，经C2椎体进入C1转移性溶骨性椎体病变，对C1进行PVP，随后对C2进行PVP。
术后患者立即报告疼痛明显缓解（从术前VAS 9/10降至3/10）。术后12小时，活动范围也有所改善。无手术相关并发症。术后即刻颈椎平片和计算机断层扫描显示溶骨性病变充填良好，骨水泥无明显渗漏。3个月的临床随访显示疼痛状况改善并维持（VAS 1/10）。
当经口入路不合适或禁忌时，经咽后前路可能是C1转移瘤患者的有效替代方法，可实现骨水泥的充分充填并显著缓解疼痛。基于我们的初步探索，仅在C形臂透视辅助下，该方法在局部麻醉和静脉镇痛下对C1进行PVP是可行的。然而，考虑到潜在的重大风险，这一技术要求较高的手术应由经验丰富的术者进行。
