• Giovanni Carlo Anselmetti, Antonio Manca, Filippo Montemurro, Sean Tutton, Gabriele Chiara, Massimo Battistella, Maurizio Savojardo, Stefano Marcia, Salvatore Masala, and Daniele Regge.
• Institute for Cancer Research and Treatment Candiolo, Turi, Italy. giovanni.anselmetti@ircc.it
• Pain Physician. 2012 Jan 1;15(1):35-42.

BackgroundVertebroplasty is a minimally invasive procedure demonstrated to be safe and effective in the treatment of painful osteoporotic and malignancy related fractures when performed in the thoracolumbar spine. Multiple randomized and nonrandomized reports have demonstrated its effectiveness. Conversely, transoral vertebroplasty (TOV) to treat the second cervical vertebra (C2) has been described in only a few case reports.ObjectivesProspective evaluation of clinical results of TOV performed in malignant painful osteolytic lesions of C2.Study DesignTOV was performed in 25 consecutive patients suffering from high-grade cervical pain due to malignant involvement of C2 who failed conservative therapies and did not have surgical indications. Follow-up was prospectively evaluated with clinical interviews in all patients. The Internal Review Board approved this study.SettingInstitute for Cancer Research and TreatmentMethodsTwenty-five patients (16 women and 9 men; mean age 59.3 ± 11.5) suffering from a painful malignant involvement of C2 who did not respond to conventional therapies and did not have surgical indications, underwent TOV for pain palliation. The procedure was performed under general anesthesia with combined digital fluoroscopy and computed tomography guidance. After a beveled vertebroplasty needle was manually advanced up to the posterior odontoid wall, bone cement was injected under continuous digital fluoroscopic control. Patients were discharged from the hospital the next procedural day. The Visual Analog Scale (VAS) for pain, analgesic requirement, and use of external cervical cast support were used for evaluating efficacy. The main end point was safety and efficacy at day 15 after the procedure. Furthermore, all the patients were scheduled to be followed-up at months one, 3, and 6, and every 6 months thereafter.ResultsThe median pretreatment VAS of 8 (range 5-10) significantly dropped (P < 0.0001) to 0 (range 0-10), with 20 patients (80%) achieving complete pain relief at day 15 after TOV. Differences in pre- and post-treatment analgesic therapy were significant (P < 0.001). Twenty-three patients no longer used a cervical cast after TOV (92%, P < 0.001). At median overall follow-up of 16 months (range 6-60 months), the projected proportion of patients free from worsening pain at 6, 12, and 24 months was 96%, 96% and 92% respectively.LimitationsA randomized study of only 25 patients.ConclusionTOV is safe, effective, and long-lasting in the treatment of cervical pain resulting from malignant involvement of C2.

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