Balloon Kyphoplasty and Additional Anterior Odontoid Screw Fixation for Treatment of Unstable Osteolytic Lesions of the Vertebral Body C2: a Case Series

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2018 Jul 28

PMID 30049274

Citations 3

Authors

Anna Voelker

Nicolas H von der Hoeh

Christoph-Eckhard Heyde

Affiliations

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Abstract

Background: Unstable osteolytic lesions of the occipitocervical junction are rare and may occur in hematological malignancy or vertebral hemangioma, among others. Different case reports have been published about vertebroplasty for treatment of spinal metastases of the upper cervical spine. Only few cases concern balloon kyphoplasty of C2. We present a consecutive case series including four patients with an osteolytic lesion of the dens axis and describe a technical note for balloon kyphoplasty of C2 and an additional anterior odontoid screw fixation.

Methods: Four consecutive patients with an osteolytic lesion of the vertebral body of C2 were treated by anterior balloon kyphoplasty and additional anterior odontoid screw fixation of the dens axis. The radiological imaging showed a lytic process of the vertebral body C2 with no vertebral collapse but involvement of more than 50% of the vertebral body in all patients.

Results: Two cases of potentially unstable osteolytic lesions of C2 by myeloma, one case with metastatic osteolytic lesion of C2 by adenocarcinoma of the colon and one patient with vertebral hemangioma located in C2 were presented to our clinic. In all cases, surgical treatment with an anterior balloon kyphoplasty of C2 and an additional anterior, bicortical odontoid screw placement was performed. Control x-rays showed sufficient osteosynthesis and cement placement in the vertebral body C2.

Discussion: Anterior balloon kyphoplasty and anterior odontoid screw placement is a safe treatment option for large osteolytic lesions of C2. The additional odontoid screw placement has the advantage of providing more stabilization and may prevent late complications, like odontoid fractures. For patients with potentially unstable or large osteolytic lesions of the dens without spinal cord compression or neurological symptoms we recommend the placement of an anterior odontoid screw when performing a balloon kyphoplasty.

Level Of Evidence: - IV: retrospective or historical series.

Citing Articles

Transoral balloon kyphoplasty in a myeloma patient with painful osseous destruction of the corpus vertebrae axis.

Andresen J, Widhalm H, Andresen R J Surg Case Rep. 2024; 2024(1):rjae009.

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Percutaneous Image-Guided Anterior Screw Fixation of the Odontoid Process.

Autrusseau P, Heidelberg D, Stacoffe N, Dalili D, Cazzato R, Koch G Cardiovasc Intervent Radiol. 2021; 44(4):647-653.

PMID: 33388865 DOI: 10.1007/s00270-020-02734-9.

Stent augmentation of an anterior odontoid screw for type 2 odontoid fracture-dislocation in the elderly population: Report of two cases and literature review.

Kapoor S, Herschkovich O, Lucantoni C, Boszczyk B J Craniovertebr Junction Spine. 2020; 10(4):254-258.

PMID: 32089621 PMC: 7008655. DOI: 10.4103/jcvjs.JCVJS_91_19.

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