C2/C3 pathologic fractures from polyostotic fibrous dysplasia of the cervical spine treated with percutaneous vertebroplasty

Abstract

We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of patients with severe fibrous dysplasia of the spine with multiple cervical lesions and C2-C3 pathologic fractures that may not be a good surgical candidate. Polyostotic fibrous dysplasia involvement of the cervical spine is rare. Review of literature indicates only few reported cases of surgical management with one case of mortality indicating increased risks associated with surgical intervention. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization for fibrous dysplasia has not been reported. A 35-year-old man with McCune-Albright syndrome and severe polyostotic fibrous dysplasia of C2 and C3 vertebrae presented with severe neck pain, radiculopathy, quadriparesis and myelopathy. The lesion had pathologic fractures, and there was an os odontoideum with cervical cord atrophy at the C1 level. After discussing need for aggressive surgical management and potential complications, we offered PVP due to surgical risks involved. PVP was performed with a posterolateral transpedicular approach without complication. The patient had remarkable improvement in clinical relief of neck pain and improvement of myelopathic symptoms at 1-year follow-up. We present a case that illustrates a potential use of PVP in the management of a patient with symptomatic spinal fibrous dysplasia with associated pathologic fractures who was poor surgical candidate.

Spinal polyostotic fibrous dysplasia in two adults: Does only biopsy unravel the mystery?

“…Though fracture is a common complication of FD of extremities, it is rarely noted in spine. [1213] The fracture in our patient could be due to the multiple falls he sustained.…”

Minimally invasive anterior vertebroplasty for C-2 metastatic lesions

“…The transpedicular approach is performed utilizing a left posterolateral trajectory under image guidance through hypertrophic diseased bone in polyostotic fibrous dysplasia. 4,7,25 Likewise, there are anecdotal reports of cases in which percutaneous vertebroplasty was performed for a traumatic C-2 VB fracture.…”

Ostéochondrodysplasies

“…Tous les étages rachidiens peuvent être affectés [124,212,224,253], même si l'atteinte cervicale semble la plus rare . Un tassement vertébral peut être associé [63,128,167,189,195,241] . Les compressions médullaires et radiculaires sont rares [48,70,99,245,247] .…”