Cervical vertebroplasty under sedoanalgesia using combined ultrasonography and fluoroscopy guidance: a novel technique.

Purpose: The aim of this report was to describe a case using combined USG and fluoroscopy for cervical VP via a percutaneous route under sedoanalgesia.

Methods: A 70-year-old male patient had severe neck pain for 6 weeks because of metastatic mass lesions in C6. After the decision to VP, the patient was placed on the operating table and 2 mg midazolam and 75 µg fentanyl were administered for conscious sedation. Localisation of the carotid artery, internal jugular vein, and trachea had been determined with USG. 3 mL of 2% lidocaine was infiltrated after proceeding a needle from the axis of the trochar to the C6 vertebra corpus. The trochar entered into the vertebra corpus between the carotid artery and trachea right-antero-laterally under C-arm and USG guidance. 6 mL of PMMA was injected into this field. Then C6 VP procedure had been completed without complications.

Results: This case has three differences from studies in the literature. First, cervical VP was conducted under sedoanalgesia. The second important feature of this case is that cervical VP was performed via a percutaneous route. A third important feature of this case is that it was performed under USG guidance for the first time in the literature.

Conclusion: We consider that the combined use of C-arm fluoroscopy and USG should improve success rates and prevent vascular and neural injuries and dura perforation.