Beyaz Serbülent Gökhan, Sayhan Havva, İnanmaz Mustafa Erkan, Orhan Mustafa
Department of Anesthesiology and Pain Medicine, Sakarya University Faculty of Medicine, Adapazarı, Sakarya, Turkey.
Anesthesiology and Pain Medicine, Sakarya University Training Research Hospital, Korucuk Campus, 54290, Adapazarı, Sakarya, Turkey.
Eur Spine J. 2018 Jul;27(Suppl 3):353-358. doi: 10.1007/s00586-017-5276-3. Epub 2017 Sep 8.
The aim of this report was to describe a case using combined USG and fluoroscopy for cervical VP via a percutaneous route under sedoanalgesia.
A 70-year-old male patient had severe neck pain for 6 weeks because of metastatic mass lesions in C6. After the decision to VP, the patient was placed on the operating table and 2 mg midazolam and 75 µg fentanyl were administered for conscious sedation. Localisation of the carotid artery, internal jugular vein, and trachea had been determined with USG. 3 mL of 2% lidocaine was infiltrated after proceeding a needle from the axis of the trochar to the C6 vertebra corpus. The trochar entered into the vertebra corpus between the carotid artery and trachea right-antero-laterally under C-arm and USG guidance. 6 mL of PMMA was injected into this field. Then C6 VP procedure had been completed without complications.
This case has three differences from studies in the literature. First, cervical VP was conducted under sedoanalgesia. The second important feature of this case is that cervical VP was performed via a percutaneous route. A third important feature of this case is that it was performed under USG guidance for the first time in the literature.
We consider that the combined use of C-arm fluoroscopy and USG should improve success rates and prevent vascular and neural injuries and dura perforation.
本报告旨在描述一例在镇静镇痛下经皮途径联合超声（USG）和荧光透视进行颈椎椎体成形术（VP）的病例。
一名70岁男性患者因C6转移性肿块病变出现严重颈部疼痛6周。决定进行VP手术后，患者被安置在手术台上，给予2mg咪达唑仑和75μg芬太尼进行清醒镇静。通过超声确定颈动脉、颈内静脉和气管的位置。从套管针轴进针至C6椎体后，注入3mL 2%利多卡因。在C形臂和超声引导下，套管针经右前外侧进入颈动脉和气管之间的椎体。向该区域注入6mL聚甲基丙烯酸甲酯（PMMA）。然后C6椎体成形术顺利完成，无并发症。
该病例与文献中的研究有三点不同。第一，颈椎椎体成形术在镇静镇痛下进行。该病例的第二个重要特征是经皮途径进行颈椎椎体成形术。该病例的第三个重要特征是文献中首次在超声引导下进行。
我们认为，C形臂荧光透视和超声联合使用应能提高成功率，预防血管和神经损伤以及硬脊膜穿孔。
