gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Malignant osteolysis of C2 treated by vertebroplysty in a biplane fluoroscopy setting

Offene Vertebroplastie und Rekonstruktion von HWK 2 bei ausgedehnen malignen Osteolysen

Meeting Abstract

  • corresponding author J. Herdmann - Spine Unit, Department of Neurosurgery, University of Düsseldorf
  • B. Turowski - Department of Neuroradiology, University of Düsseldorf
  • F. Rommel - Spine Unit, Department of Neurosurgery, University of Düsseldorf
  • A. Röhrig - Spine Unit, Department of Neurosurgery, University of Düsseldorf
  • S. Persits - Spine Unit, Department of Neurosurgery, University of Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-12.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0149.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Herdmann et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Osteolysis of the axis leads to severe neck pain even if the vertebra has not collapsed and if there still is a physiological profile of the craniocervical junction. Surgical stabilization and/or reconstruction involves major surgery. Following the pioneering work of H. Deramond regarding vertebroplastic treatment of C2-lesions, we aimed at a safe and restrictedly invasive technique for a complete reconstructive filling of osteolytic C2-lesions.

Methods

In 5 consecutive cases of extensive C2-osteolysis involving both the base as well as the dens of the axis (4 plasmocytoma, 1 breast cancer; 1 male, 4 female; age 59-81 years) we used an open approach to the axis with a ventral skin incision at the level of C4. Surgical steps do not differ from the procedure for placing odontoid screws. The tip of an 11g needle is carefully manoeuvred into the osteolysis using biplane fluoroscopy. A vertebral angiography/phlebography through the vertebroplasty needle provides the necessary information about large-scale major draining veins. High contrast vertebroplasty cement (Osteopal V™) is then slowly injected using a screw-cylinder-type application system (Cemento™) that allows for a highly precise injection of small quantities of cement. Cement distribution is controlled by biplane fluoroscopy with intermittent rotation to precisely follow the filling of the pedicles. This flow of cement can else not be differentiated from an erroneous and disastrous filling of the spinal canal.

Results

In the patient with breast cancer we observed a cement leakage to the right atlantoaxial joint that led to the picture of a complete arthrography. Nevertheless, the osteolysis was also properly filled with cement. This and three more patients showed immediate and complete pain relief. One 81-year-old woman with plasmocytoma continued to complain of intractable neck pain despite excellent cement filling of the osteolysis. There were no complications that led to any worsening or to a neurological deficit.

Conclusions

Vertebroplasty of extensive C2-osteolysis is a technically demanding procedure. A high-quality biplane digital fluoroscopy is essential to control cement flow around the spinal canal. The open approach minimizes any additional risks such as infection (transoral) or uncontrolled parapharyngeal bleeding (percutaneous). An excellent pain relief in 4 of 5 patients is a promising result in view of the lack of alternative procedures.