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Spine
Case series
Transoral vertebroplasty for the C1 lateral mass
  1. Frédéric Clarençon1,2,
  2. Eimad Shotar2,
  3. Evelyne Cormier2,
  4. Kevin Premat1,2,
  5. Mehdi Drir3,
  6. Ghizlene Lahlou1,4,
  7. Veronique Morel5,
  8. Jean-Philippe Spano1,6,
  9. Raphaël Bonaccorsi7,
  10. Federico Di Maria8,
  11. Rémi Hervochon4,
  12. Hugues Pascal-Mousselard1,7,
  13. Jacques Chiras1,2
  1. 1 Sorbonne Université, Paris, France
  2. 2 Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
  3. 3 Department of Neuro-intensive care, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
  4. 4 Department of Otorhinolaryngology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
  5. 5 Department of Hematology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
  6. 6 Department of Oncology, Hôpitaux Universitaires Pitié Salpêtrière – Charles Foix, Paris, France
  7. 7 Department of Orthopedic Surgery, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
  8. 8 Department of Neuroradiology, Hospital Foch, Suresnes, France
  1. Correspondence to Dr Frédéric Clarençon, Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris 75013, France; fredclare5{at}gmail.com

Abstract

Background Osteolytic lesions of the atlas (C1) are challenging to treat by vertebroplasty due to the vicinity of the vertebral artery and the spinal cord.

Objective To present our experience with transoral vertebroplasty (TOV) for osteolytic lesions of the lateral mass of the atlas.

Methods Retrospective case series involving 15 consecutive patients (nine male, six female, mean age 63 years) who underwent TOV for the treatment of an osteolytic lesion of the lateral mass of the atlas. Among the osteolytic lesions, 10/15 (67%) were bone metastases from various cancers; 4/15 (27%) were lesions related to multiple myeloma; and one lesion (7%) was an aggressive hemangioma. All the TOVs were performed under general anesthesia and in most cases (10/15; 67%) in a hybrid angiosuite combining a C-arm flat panel and a CT scan. The remaining five patients were treated under biplane fluoroscopic guidance.

Results Vertebroplasty of the lateral mass of C1 through a transoral route was feasible in all cases. Significant pain relief was obtained in most cases (1 month average decrease in Numeric Rating Scale: 4.9±4.1). No major complication was recorded. In 7/15 cases (47%), cement leakage surrounding the C1 lateral mass was seen; none of these leakages had a significant clinical consequence. No additional spine surgery was required in any of the patients.

Conclusion TOV of osteolytic lesions of the lateral mass of the atlas is feasible and seems safe and effective, providing pain relief and bone stabilization.

  • cervical
  • metastatic
  • spine

https://doi.org/10.1136/neurintsurg-2020-015853

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    Footnotes

    • Contributors FC: data collection, manuscript writing. ES:data collection, critical review of the manuscript. EC, KP, FDM: data collection. MD, GL, VM, RB, J-PS, RH, HP-M, JC: critical review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests FC reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; non-related to the study), Codman Neurovascular and Microvention (core laboratory; non-related to the study).

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.