Percutaneous vertebroplasty at C7 for the treatment of painful metastases -A case report-
A 51-year-old woman with breast cancer had been experiencing severe neck pain for 2 months. She felt severe weight-bearing pain in her neck, and occasionally radiating to her entire right arm, even after undergoing radiation therapy. Imaging studies revealed an osteolytic compression fracture in the C7 vertebra ().\nThe patient refused to undergo open corpectomy with fusion; therefore, we decided to perform PVP at C7. Permission for a clinical trial was granted by the Institutional Review Board from the hospital, and informed consent about potential complications, including nerve injury, bleeding, tracheo-esophageal injury, wound infection, and embolism, was obtained from the patient. The patient received 1 g of cefazolin intravenously 30 min before the operation. The procedure was performed under conscious sedation with basic monitoring such as electrocardiography, pulse oximetry, and noninvasive monitoring of blood pressure. The patient was placed in the supine position on a radiolucent table with an inflatable, adjustable pillow placed behind her neck. After aseptic draping, local anesthesia was provided with a 5 ml of 1% lidocaine and intravenous analgesia with 30 mg of ketorolac and 100 µg of fentanyl.\nA right-handed operator pushed tracheo-esophageal complex toward the opposite side with the left index and middle fingers; subsequently the operator inserted these fingers inside towards the front of the vertebral body []. An additional 2 ml of 1% lidocaine was administered on the anterior longitudinal ligament and periosteum of the anterior C7 vertebral body. A 13 gauge, 10 cm long bone biopsy needle was inserted into the left side of the patient's neck. The needle was advanced into the anterior 1/3 anterior 1/3 or 1/2 of the vertebral body by hammering, which was necessary because of the hardness of the cortex of the vertebral body. After confirming needle placement and ensuring that no contrast medium was leaking into the vessels or epidural space, 2 ml of cement was injected ().\nImmediately after the operation, the patient could stand and sit without neck pain. There were no complications, such as bleeding, vagus nerve injury, tracheo-esophageal injury, cement leakage or embolism. Fortunately, no evidence of new metastases was found and her neck pain was gone completely during the 6 month follow-up.