Minimally invasive percutaneous C1–C2 transarticular screw fixation as a palliative management option in C2 metastases

Abstract

Bone metastasis in patients with esophageal carcinoma is rare but serious, often resulting in structural complications of the spine such as atlantoaxial instability and C2 metastases. Atlantoaxial instability is usually managed surgically using screw-rod constructs; however, in patients undergoing radiotherapy, surgical wound healing is a concern. We present a technical note involving a terminally ill patient diagnosed with esophageal carcinoma who suffered from a metastatic lytic lesion of C2 and mechanical neck pain. Due to the patient starting palliative radiotherapy, a percutaneous approach and transarticular screws were used to achieve atlantoaxial fixation and minimize the surgical wound while maintaining the midline tension band. Significant clinical improvement was found. Our patient was able to begin palliative radiotherapy within 1 week of surgery, without surgical and wound complications. This report provides unique insight into the utilization of a minimally invasive approach for pain management and stabilization of the cervical spine for oncology patients.