A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case report
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 transor...
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Elsevier
2025-09-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043325004716 |
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| author | Joe Khoury, DO, MBA, RPVI Brendan Ryu, MD Shima Tafreshi, MD Drew M. Caplin, MD |
| author_facet | Joe Khoury, DO, MBA, RPVI Brendan Ryu, MD Shima Tafreshi, MD Drew M. Caplin, MD |
| author_sort | Joe Khoury, DO, MBA, RPVI |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e9b548d636d643f283fc62be3e2c6463 |
| institution | OA Journals |
| issn | 1930-0433 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj-art-e9b548d636d643f283fc62be3e2c64632025-08-20T02:36:45ZengElsevierRadiology Case Reports1930-04332025-09-012094196420210.1016/j.radcr.2025.05.042A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case reportJoe Khoury, DO, MBA, RPVI0Brendan Ryu, MD1Shima Tafreshi, MD2Drew M. Caplin, MD3Division of Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, GA 30322, USA; Corresponding author.Department of Emergency Medicine, Transitional Year Program, South Shore University Hospital, Bay Shore, NY, USADepartment of Radiology, Division of Vascular and Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USADepartment of Radiology, Division of Vascular and Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USAImage-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.http://www.sciencedirect.com/science/article/pii/S1930043325004716C2CervicalVertebroplastyVertebral augmentationMultimodal |
| spellingShingle | Joe Khoury, DO, MBA, RPVI Brendan Ryu, MD Shima Tafreshi, MD Drew M. Caplin, MD A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case report Radiology Case Reports C2 Cervical Vertebroplasty Vertebral augmentation Multimodal |
| title | A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case report |
| title_full | A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case report |
| title_fullStr | A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case report |
| title_full_unstemmed | A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case report |
| title_short | A novel multimodal approach to C2 vertebroplasty in the setting of osteolytic metastases: A case report |
| title_sort | novel multimodal approach to c2 vertebroplasty in the setting of osteolytic metastases a case report |
| topic | C2 Cervical Vertebroplasty Vertebral augmentation Multimodal |
| url | http://www.sciencedirect.com/science/article/pii/S1930043325004716 |
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