Khoury Joe, Ryu Brendan, Tafreshi Shima, Caplin Drew M
Division of Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, GA 30322, USA.
Department of Emergency Medicine, Transitional Year Program, South Shore University Hospital, Bay Shore, NY, USA.
Radiol Case Rep. 2025 Jun 4;20(9):4196-4202. doi: 10.1016/j.radcr.2025.05.042. eCollection 2025 Sep.
Image-guided vertebral augmentation effectively treats pathologic vertebral lesions, though managing pathology in the cervical spine presents unique challenges. Posterolateral approaches, while safer, require prone positioning that may not be feasible for all patients. Open anterolateral and transoral approaches increase infection risk and typically require general anesthesia. We present a novel multimodal anterolateral approach using ultrasound, fluoroscopy, and cone-beam CT for percutaneous C2 vertebral augmentation in a patient with metastatic lesions. A 72-year-old man with multiple myeloma presented with a C2 vertebral body lytic lesion at high risk for dislocation. Due to presence of a stabilizing cervical collar and the risk associated with prone positioning, vertebral augmentation access was limited. With the patient in supine position, we utilized cone-beam CT with overlay guidance to plan a right lateral trajectory. Ultrasound identified vital vasculature, enabling targeted hydrodissection to create a safe access path with real-time image-guidance. An 11G trocar needle was advanced under ultrasound guidance, with intermittent cone-beam CT adjustments to ensure precise placement. After confirming access to the right lateral mass of C2 via fluoroscopy, 3.5cc of PMMA cement was successfully injected without extravasation. The patient experienced no complications or neurologic deficits on follow-up and was cleared to remove the cervical collar 10 days postprocedure. This case demonstrates the feasibility and efficacy of a multimodal anterolateral approach for C2 vertebral augmentation when conventional approaches are contraindicated. By integrating ultrasound-guided hydrodissection with advanced imaging, this technique offers a safe alternative for anatomically constrained patients while avoiding the risks associated with traditional approaches.
影像引导下的椎体强化术能有效治疗病理性椎体病变，不过处理颈椎病变存在独特挑战。后外侧入路虽更安全，但需要俯卧位，这对所有患者而言可能并不可行。开放前外侧和经口入路会增加感染风险，且通常需要全身麻醉。我们展示了一种新颖的多模式前外侧入路，该入路使用超声、荧光透视和锥形束CT，用于一名患有转移性病变患者的经皮C2椎体强化术。一名72岁的多发性骨髓瘤男性患者，其C2椎体出现溶骨性病变，存在脱位的高风险。由于佩戴了稳定的颈托以及俯卧位相关风险，椎体强化术的入路受限。患者仰卧位时，我们利用带叠加引导的锥形束CT规划右侧入路轨迹。超声识别出重要血管，通过实时影像引导进行靶向水分离以创建安全的入路通道。在超声引导下推进一根11G套管针，并通过间歇性锥形束CT调整以确保精确放置。经荧光透视确认进入C2右侧块后，成功注射3.5cc聚甲基丙烯酸甲酯骨水泥且无渗漏。患者在随访中未出现并发症或神经功能缺损，术后10天被允许移除颈托。该病例证明了在传统方法禁忌时，多模式前外侧入路用于C2椎体强化术的可行性和有效性。通过将超声引导下的水分离与先进成像技术相结合，该技术为解剖结构受限的患者提供了一种安全的替代方法，同时避免了传统方法相关的风险。
