Wang Kuo-Wei, Wang Hao-Kuang, Lu Kang, Liang Cheng-Loong, Chen Ya-Wen, Liliang Po-Chou
E-Da Hospital, I-Shou University, Neurosurgery Kaohsiung, Taiwan.
Pain Physician. 2016 May;19(4):E625-9.
C2 vertebroplasty is more challenging than transpedicular percutaneous vertebroplasty in the thoracic and lumbar spine.
We report an anterior ascending approach for C2 percutaneous vertebroplasty to avoid potential injury to vital structures surrounding the C2 vertebra.
A technique note with 5 consecutive cases.
Neurosurgery department of a university hospital.
Fluoroscopically guided manual compression was applied using 3 fingers at the C5 level between the muscle and trachea. The larynx and trachea were displaced medially and the carotid artery laterally. The anterior cervical spine was palpated, and a 15-gauge 4-inch bone marrow biopsy needle was introduced through an anterior ascending approach. When the tip touched the intervertebral disc between C2 and C3, the needle was pushed through the disc until it penetrated into the C2 vertebral body. After confirming adequate needle insertion, vertebroplasty was performed.
Pain relief was achieved in 4/5 (80%) patients. One patient possibly did not benefit from percutaneous vertebroplasty, and asymptomatic cement extravasation was detected in 2 patients.
Sample size; impossibility of placebo control.
An anterior ascending approach for C2 percutaneous vertebroplasty is a valuable alternative for relieving pain caused by metastatic spinal tumors. This approach is familiar to surgeons performing anterior cervical discectomies, percutaneous nucleoplasty, or odontoid screw placement surgeries.
Vertebroplasty, pain, axis, cement leak, metastases, palliative medicine, spine, fracture.
与胸腰椎经椎弓根经皮椎体成形术相比，C2椎体成形术更具挑战性。
我们报告一种用于C2经皮椎体成形术的前路斜行入路，以避免对C2椎体周围重要结构造成潜在损伤。
一项包含5例连续病例的技术说明。
一所大学医院的神经外科。
在C5水平，于肌肉与气管之间用3个手指进行透视引导下的手动压迫。将喉和气管向内侧移位，颈动脉向外侧移位。触诊颈椎前路，通过前路斜行入路插入一根15号4英寸的骨髓活检针。当针尖触及C2和C3之间的椎间盘时，将针推过椎间盘直至刺入C2椎体。确认针插入位置合适后，进行椎体成形术。
4/5（80%）的患者疼痛得到缓解。1例患者可能未从经皮椎体成形术中获益，2例患者检测到无症状的骨水泥渗漏。
样本量；无法进行安慰剂对照。
C2经皮椎体成形术的前路斜行入路是缓解转移性脊柱肿瘤所致疼痛的一种有价值的替代方法。这种入路对于进行颈椎前路椎间盘切除术、经皮髓核成形术或齿状突螺钉置入手术的外科医生来说并不陌生。
椎体成形术；疼痛；枢椎；骨水泥渗漏；转移瘤；姑息医学；脊柱；骨折
