Skip to main content

Advertisement

SpringerLink
Log in

C2 stentoplasty: an alternative to conventional vertebroplasty in the treatment of axis metastatic lesions: a systematic review with meta-analysis and case series

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

Vertebroplasty has been recently described in the literature as a potential treatment for C2 metastatic lesions. Stentoplasty may represent a safest and equally alternative to the latter.

Objective

To describe a novel technique, stentoplasty, as an alternative for the treatment of metastatic involvement of C2 and to assess its efficacy and safety. To systematically evaluate the pertinent literature regarding the clinical outcomes and complications of C2 vertebroplasty in patients with metastatic disease.

Methods

A systematic review of C2 vertebroplasty, in the English language medical literature was conducted for the needs of this study. Additionally, a cohort of five patients, presenting with cervical instability (SINS > 6) and/or severe pain (VAS > 6) from metastatic involvement of C2 and treated with stentoplasty in our department is presented. Outcomes evaluated include, pain control, stability, and complications.

Results

Our systematic review yielded 8 studies that met the inclusion criteria, incorporating 73 patients that underwent C2 vertebroplasty for metastatic disease. There was a reduction in VAS scores following surgery from 7.6 to 2.1. Eleven patients had complications (15%), 3 (4%) required additional stabilization and decompression, 6 (8.2%) had odynophagia and the incidence of cement leak was 31.5% (23/73). With regard to our cohort, all 5 patients presented with severe neck pain (average VAS 6.2 (2–10)) with or without instability (average SINS 10 (6–14)) and underwent C2 stentoplasty. Mean duration of the procedures was 90 min (61–145) and 2.6 mls (2–3) of cement was injected. Postoperatively VAS improved from 6.2 to 1.6 (P = 0.033). No cement leak or other complications were recorded.

Conclusion

A systematic review of the literature demonstrated that C2 vertebroplasty can offer significant pain improvement with a low complication rate. At the same time, this is the first study to describe stentoplasty in a small cohort of patients, as an alternative for the treatment of C2 metastatic lesions in selected cases, offering adequate pain control and improving segmental stability with a high safety profile.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

Data availability

The data that support the findings of this study are available on request from the corresponding author.

Code availability

Not applicable.

References

  1. Jenis LG, Dunn EJ, An HS (1999) Metastatic disease of the cervical spine. Rev Clin Orthop Relat Res 359:89–103. https://doi.org/10.1097/00003086-199902000-00010

    Article  Google Scholar 

  2. Sherk HH (1975) Lesions of the atlas and axis. Clin Orthop Relat Res 109:33–41. https://doi.org/10.1097/00003086-197506000-00005

    Article  Google Scholar 

  3. Bilsky MH, Shannon FJ, Sheppard S, Prabhu V, Boland PJ (2002) Diagnosis and management of a metastatic tumor in the atlantoaxial spine. Spine 27(10):1062–9. https://doi.org/10.1097/00007632-200205150-00011

    Article  PubMed  Google Scholar 

  4. Vieweg U, Meyer B, Schramm J (2001) Tumour surgery of the upper cervical spine–a retrospective study of 13 cases. Acta Neurochir 143(3):217–225. https://doi.org/10.1007/s007010170101

    Article  CAS  PubMed  Google Scholar 

  5. Stangenberg M, Viezens L, Eicker SO, Mohme M, Mende KC, Dreimann M (2017) Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases. Neurosurg Focus 43(2):E3. https://doi.org/10.3171/2017.5.FOCUS17175

    Article  PubMed  Google Scholar 

  6. Anselmetti GC, Manca A, Montemurro F, Tutton S, Chiara G, Battistella M, Savojardo M, Marcia S, Masala S, Regge D (2012) Vertebroplasty using transoral approach in painful malignant involvement of the second cervical vertebra (C2): a single-institution series of 25 patients. Pain Phys 15(1):35–42

    Article  Google Scholar 

  7. Galibert P, Deramond H, Rosat P, Le Gars D (1987) Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie 33(2):166–8

    CAS  PubMed  Google Scholar 

  8. Pilitsis JG, Rengachary SS (2001) The role of vertebroplasty in metastatic spinal disease. Neurosurg Focus 11(6):e9. https://doi.org/10.3171/foc.2001.11.6.10

    Article  CAS  PubMed  Google Scholar 

  9. Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E (1996) Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology 199(1):241–247. https://doi.org/10.1148/radiology.199.1.8633152

    Article  CAS  PubMed  Google Scholar 

  10. Patel AA, Vaccaro AR, Martyak GG, Harrop JS, Albert TJ, Ludwig SC, Youssef JA, Gelb DE, Mathews HH, Chapman JR, Chung EH, Grabowski G, Kuklo TR, Hilibrand AS, Anderson DG (2007) Neurologic deficit following percutaneous vertebral stabilization. Spine 32(16):1728–34. https://doi.org/10.1097/BRS.0b013e3180dc9c36

    Article  PubMed  Google Scholar 

  11. Floeth FW, Herdmann J, Rhee S, Turowski B, Krajewski K, Steiger HJ, Eicker SO (2014) Open microsurgical tumor excavation and vertebroplasty for metastatic destruction of the second cervical vertebra-outcome in seven cases. Spine J 14(12):3030–3037. https://doi.org/10.1016/j.spinee.2014.09.018

    Article  PubMed  Google Scholar 

  12. Martín-López JE, Pavón-Gómez MJ, Romero-Tabares A, Molina-López T (2015) Stentoplasty effectiveness and safety for the treatment of osteoporotic vertebral fractures: a systematic review. Orthop Traumatol Surg Res 101(5):627–632. https://doi.org/10.1016/j.otsr.2015.06.002

    Article  PubMed  Google Scholar 

  13. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) PRISMA-P group preferred reporting items for systematic review and meta-analysis protocols PRISMA-P statement. Syst Rev 4(1):1. https://doi.org/10.1186/2046-4053-4-1

    Article  PubMed  PubMed Central  Google Scholar 

  14. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2021) Cochrane handbook for systematic reviews of interventions, Version 6.2. Cochrane, Oxford

    Google Scholar 

  15. Moulin B, Brisse H, Dutertre G, Brenet O, Queinnec M, Cottu P, Zadegan F, Moreau S, Benchimol R, Cao K, Servois V (2021) CT-guided vertebroplasty of first (C1) or second (C2) cervical vertebra using an electromagnetic navigation system and a transoral approach. Diagn Interv Imaging 102(9):571–575. https://doi.org/10.1016/j.diii.2021.04.007

    Article  PubMed  Google Scholar 

  16. Mont’Alverne F, Vallée JN, Cormier E, Guillevin R, Barragan H, Jean B, Rose M, Chiras J (2005) Percutaneous vertebroplasty for metastatic involvement of the axis. AJNR Am J Neuroradiol 26(7):1641–1645

    PubMed  PubMed Central  Google Scholar 

  17. Sun G, Jin P, Li M, Liu X, Li F, Yu AK, Lu Y (2010) Percutaneous vertebroplasty for treatment of osteolytic metastases of the C2 vertebral body using anterolateral and posterolateral approach. Technol Cancer Res Treat 9(4):417–422. https://doi.org/10.1177/153303461000900411

    Article  PubMed  Google Scholar 

  18. Wang KW, Wang HK, Lu K, Liang CL, Chen YW, Liliang PC (2016) Fluoroscopically guided C2 percutaneous vertebroplasty: a surgical technique note on an anterior ascending approach. Pain Phys 19(4):E625–E629

    Google Scholar 

  19. Rhiew R, Manjila S, Dezure A, Tabbosha M, Guthikonda M, Eltahawy H (2008) Minimally invasive anterior vertebroplasty for C-2 metastatic lesions. Neurosurg Focus 25(2):E4. https://doi.org/10.3171/FOC/2008/25/8/E4

    Article  PubMed  Google Scholar 

  20. Ishii T, Mukai Y, Hosono N, Sakaura H, Nakajima Y, Sato Y, Sugamoto K, Yoshikawa H (2004) Kinematics of the upper cervical spine in rotation: in vivo three-dimensional analysis. Spine 29(7):E139-44. https://doi.org/10.1097/01.brs.0000116998.55056.3c

    Article  PubMed  Google Scholar 

  21. Vender JR, McDonnell DE (2001) Management of lesions involving the craniocervical junction. Neurosurg Q 11(2):151–171. https://doi.org/10.1097/00013414-200106000-00007

    Article  Google Scholar 

  22. Fourney DR, York JE, Cohen ZR, Suki D, Rhines LD, Gokaslan ZL (2003) Management of atlantoaxial metastases with posterior occipitocervical stabilization. J Neurosurg 98(2 Suppl):165–170. https://doi.org/10.3171/spi.2003.98.2.0165

    Article  PubMed  Google Scholar 

  23. Delank KS, Wendtner C, Eich HT, Eysel P (2011) The treatment of spinal metastases. Dtsch Arztebl Int 108(5):71–9. https://doi.org/10.3238/arztebl.2011.0071

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gilbert HA, Kagan AR, Nussbaum H, Rao AR, Satzman J, Chan P, Allen B, Forsythe A (1977) Evaluation of radiation therapy for bone metastases: pain relief and quality of life. AJR Am J Roentgenol 129(6):1095–1096. https://doi.org/10.2214/ajr.129.6.1095

    Article  CAS  PubMed  Google Scholar 

  25. Willert HG, Enderle A (1979) Temporäre zementplombe bei knochentumoren fraglicher dignität [temporary plugging of cystic bone tumors by bone cement (author’s transl)]. Z Orthop Ihre Grenzgeb. 117(2):224–32

    CAS  PubMed  Google Scholar 

  26. Nelson DA, Barker ME, Hamlin BH (1997) Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperth 13(3):287–306. https://doi.org/10.3109/02656739709023537

    Article  CAS  Google Scholar 

  27. Reddy AS, Hochman M, Loh S, Rachlin J, Li J, Hirsch JA (2005) CT guided direct transoral approach to C2 for percutaneous vertebroplasty. Pain Phys 8(2):235–238

    Google Scholar 

Download references

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Centre for Spinal Studies & Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK

    Elie Najjar, Rishi Rampersad, Spyridon Komaitis, Ali Mardashti & Magnum Tsegaye

Authors
  1. Elie Najjar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rishi Rampersad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Spyridon Komaitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali Mardashti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Magnum Tsegaye
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MT contributed to the study conception and design. Data collection and analysis were performed by EN and AM. The first draft of the manuscript was written by EN and all authors commented on previous versions of the manuscript. Final version of the article reviewed by MT, EN, and SK.

Corresponding author

Correspondence to Spyridon Komaitis.

Ethics declarations

Conflict of interest

All authors declare no competing interests. No financial support was provided for this study, and no potential conflict of interest or associated biases were present from any of the authors.

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Najjar, E., Rampersad, R., Komaitis, S. et al. C2 stentoplasty: an alternative to conventional vertebroplasty in the treatment of axis metastatic lesions: a systematic review with meta-analysis and case series. Eur Spine J 32, 3450–3462 (2023). https://doi.org/10.1007/s00586-023-07809-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07809-y

Keywords

Search

Navigation