Percutaneous Screw Fixation and Cementoplasty to Stabilize Unstable Osteolytic Fracture of Odontoid Process: a Case Report

We relay a case of unstable lytic secondary fracture of odontoid process (C2) treated by screw fixation and cementoplasty, using a percutaneous approach. A 62-year-old female patient followed for a breast neoplasia with bone concurrent metastases suffered from diffuse cervical pain. A CT scan showed a lytic fracture of C2. The procedure was performed using CT scan guidance under general anesthesia. After a biphasic enhanced CT scan of the neck and cervical spine, a needle was slowly inserted to hydrodissect the jugulocarotid and prevertebral spaces up to the anterior cortex of C2 using an iodinated contrast agent solution diluted 5% with saline water. Under fluoroscopy guidance and intermittent CT monitoring, a bone pin was navigated though the anterior cortex of C2 and then advanced inside the vertebral body of C2. After checking for optimal positioning of the bone pin, a 34-mm-long titanium screw was inserted into C2 until reaching the posterior cortex. The approach to the transverse fracture line of the body of the odontoid was tangential with no displacement of the bony parts. Cement injection was then performed. One month after the procedure, a CT scan showed no material displacement, and the patient had no visible skin scarring. The patient regained full mobility of the cervical spine, and the pain decreased from 7/10 before the procedure to 0/10 after the procedure according to the patient. Percutaneous screw fixation and cementoplasty to stabilize unstable osteolytic fracture of odontoid process are safe and feasible.