Percutaneous Radiofrequency-Targeted Vertebral Augmentation of Unstable Metastatic C2 and C3 Lesions Using a CT-Guided Posterolateral Approach and Ultra-High-Viscosity Cement

Study Design. Case report. Objective. To report the first technical note describing radio frequency-targeted C2 and C3 vertebral augmentation using a posterolateral approach and high-viscosity cement. Summary of Background Data. Percutaneous vertebral augmentation is a minimally invasive procedure used for stabilization and pain control in vertebral compression fractures. Its use in the cervical spine, especially the upper cervical spine, is very limited mainly due to technical challenges. Methods. We report the first use of an ultra-high-viscosity cement and posterolateral approach with computed tomography (CT) guidance and computed tomographic fluoroscopy in a patient with lytic lesions in C2 and C3 and a pathologic fracture of C2 for the purpose of stabilization and pain palliation. Results. Technically successful vertebral augmentation of the C2 and C3 vertebral bodies was achieved. There were no complications. The patient reported pain relief and improved range of motion after treatment and the hard cervical collar was removed. Conclusion. Computed tomography-guided radiofrequency-targeted vertebral augmentation of the cervical spine using a posterolateral approach and ultra-high-viscosity cement is a technically feasible procedure that may be used in patients with advanced osteolytic cervical spine metastases who are not surgical candidates for the purpose of pain palliation and fracture stabilization.