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AJNR - American Journal of Neuroradiology

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Catheter-Directed Percutaneous Transpedicular C2/C3 Vertebroplasty in a Patient with Fibrous Dysplasia Using Seldinger Technique

G. Christoforidis^a, D. Dang^a and J. Gabriel^b

^a Department of Radiology, The Ohio State University, Columbus, Ohio
^b Department of Orthopedics, The Ohio State University, Columbus, Ohio

View larger version (61K): [in a new window]   Fig 1. Lateral conventional radiograph of the cervical spine (A), sagittal postmyelogram CT reconstruction of the cervical spine (B), and axial (C) postmyelogram CT scans of this patient with a multiseptated (black arrows) C2–C3 vertebral complex (arrowheads) and disruption of the anterior wall of the vertebral body (white arrows). Note os odontoideum (OS), cord atrophy, and anterior subluxation of C1 on C2. The anterior and posterior spinal laminar lines are outlined.

View larger version (61K): [in a new window]   Fig 2. CTA (A) indicates that the carotid artery branches (short arrows) and jugular veins (arrowheads), as well as branches of the right occipital and vertebral arteries (long arrows), obscure access to the involved vertebra. Intraprocedural CT demonstrates access to the C2/C3 vertebral complex via a relatively less vascular route (B).

View larger version (73K): [in a new window]   Fig 3. AP (A) and lateral (B–D) intraprocedural fluoroscopic views demonstrate cannula (arrows) and catheter (arrowheads) placement into the superior aspect of the C2 vertebra (A and B). As in Fig 1A, the anterior and posterior laminar lines are outlined, the C2–C3 vertebral body complex is outlined with white arrowheads, and C1, C2, C3, and the os odointoideum (OS) are labeled. Figures 3B–D have the same projection. Figure 3C demonstrates successful placement of methylmethacrylate within the superior aspect of the C2–C3 vertebral body complex. Figure 3D demonstrates a continuous column within the C2–C3 vertebral complex.

View larger version (57K): [in a new window]   Fig 4. Postprocedural conventional radiographic and CT scans obtained in similar locations as in Fig 1. Note the deposition of the bone cement in multiple compartments of the vertebral complex and the tract of the cannula (arrowheads).