Overview
Malignant neoplasms affecting the cervical vertebral column, particularly C2, often present with severe pain and can be challenging to treat surgically. Transoral vertebroplasty (TOV) is an emerging minimally invasive technique for managing painful osteolytic lesions in this region.Diagnosis
Clinical Presentation: High-grade cervical pain unresponsive to conservative management.
Imaging: MRI and CT scans essential for identifying osteolytic lesions and assessing extent of involvement 1.
Biopsy: May be required to confirm malignancy, though not always feasible due to location 1.Management
First-Line: Conservative therapies including analgesics, radiation therapy, and chemotherapy 1.
Adjunctive: Transoral vertebroplasty for pain palliation in patients unsuitable for surgery 1.
Procedure Details: Minimally invasive, targeting C2 specifically in cases refractory to initial treatments 1.Special Populations
Elderly: TOV may be particularly beneficial for elderly patients where surgical risks are high 1.
Comorbidities: Patients with significant comorbidities who are poor surgical candidates may benefit from TOV 1.Key Recommendations
Consider transoral vertebroplasty as an adjunctive treatment for pain palliation in patients with malignant involvement of C2 who have failed conservative therapies and are not surgical candidates (Evidence: Weak) 1.
Utilize imaging (MRI, CT) for accurate diagnosis and assessment of osteolytic lesions before considering invasive procedures (Evidence: Moderate) 1.
Evaluate individual patient factors, including age and comorbidities, to tailor treatment approaches, favoring minimally invasive techniques when appropriate (Evidence: Expert opinion) 1.References
1 Anselmetti GC, Manca A, Montemurro F, Tutton S, Chiara G, Battistella M et al.. Vertebroplasty using transoral approach in painful malignant involvement of the second cervical vertebra (C2): a single-institution series of 25 patients. Pain physician 2012. link