C2-C3 percutaneous osteosynthesis

Cervical vertebroplasty has proven its safety and effectiveness for the treatment of osteolytic lesions of the cervical spine.1 However, secondary fractures around, or even through, the cement cast, have been reported as potential delayed complications of C2 vertebroplasties.2 Indeed, acrylic bone cement provides high resistance to compression forces but resists poorly to shear stress. The C2's odontoid process being mainly exposed to rotations and flexion-extension motions, the risk of secondary fractures may thus remain after cementoplasty alone. Anterior cervical osteosynthesis may be a mini-invasive alternative to avoid such delayed complications. This technique has been described mainly for traumatic fractures but can be considered for the management of osteolytic lesions or pathological fractures. We report here (Video 1) the successful osteosynthesis of a C2 neoplastic osteolytic lesion under fluoroscopic, CB-CT and electromagnetic system (Imactis, Grenoble, France) guidance. The procedure was performed under general anesthesia in 3 steps: 1) positioning of the bone needle through the bone lesion 2) anchoring a cannulated screw through a protected pathway using soft tissues hydrodissection and 3) cementation of both osteolytic lesion and the screw. To prevent inopportune wounding of cervical vessels, trachea or esophagus, neck hyper-extension, hydro-dissection (i.e., injection of saline diluted with contrast media in the pre-cervical soft-tissues) and electro-magnetic CB-CT guidance were performed. Finally, to enhance the stability of the fixation and avoid delayed mobilization of the material, the screw was positioned from the antero-inferior aspect of the C3 vertebral body toward the C2's odontoid process, through the C2-C3 disk.3