NSJ-Spine january 2004

Abstract

ERCUTANEOUS vertebroplasty enables minimally invasive treatment of both vertebral tumors and compression fractures of the cervical spine. The injection of radiopaque cement across a cervical spine fracture increases the strength and stiffness of the VB and has been shown to provide pain control in up to 90% of patients. Surgical Technique General anesthesia is induced and an endotracheal tube is placed. The patient's neck is oriented in a neutral position. Fluoroscopy is used to identify and demarcate the level of C-4, and the skin on the lateral neck is opened through a 2-cm incision Department of Neurological Surgery, Wayne State University, Detroit, Michigan The authors describe a technique for minimally invasive anterior vertebroplasty for treating metastatic disease of the C-2 vertebra and discuss its application in 2 cases. After a 2-cm lateral neck incision is made, blunt dissection is performed toward the anterior inferior endplate of the C-2 vertebra. An 11-gauge needle is introduced through a tubular sheath and tapped into the inferior endplate of C-2, with biplanar fluoroscopy being performed to confirm position. The needle is subsequently advanced across the fracture line and into the odontoid process. Under fluoroscopic guidance, 2 ml of methylmethacrylate is injected into the odontoid process and vertebral body. This method is advantageous as 1) hyperextension of the neck is not performed, 2) the chance of inadvertent neurovascular or submandibular gland injury is minimized, 3) the possibility of cement leakage is decreased, and 4) hemostasis is better achieved under direct vision