First percutaneous transoral clivoplasty for bone-destroying process

July 2nd, 2014 by

A young woman was referred for severe upper neck pain with a rare disorder that causes abnormal bone absorption. This had eroded the upper two cervical vertebrae and the clivus (upper neck and base of the skull). Her spine was probably not stable and she had severe (8-9/10) pain despite taking the equivalent of 30 milligrams of morphine every day.

As an outpatient, we took her to the CT scanner and, under general anesthesia, were able to fill the open bone spaces, including the clivus at the base of the skull, with bone cement. This was done with a large needle through the back of the mouth (pharynx). There was no incision to heal and she was discharged the next morning.

We just saw her back in follow-up. She has had no pain (0/10) since the time of the procedure. She is on no pain medication and has resumed all normal activities.

Although vertebroplasties (filling the vertebrae of the spine with bone cement) have been done for years, as far as we can tell, this is the first time a “clivoplasty” has been performed. We are also able to perform C-1 and C-2 vertebroplasties using a transoral, percutaneous, CT-guided approach.

Trajectory of trocar through mouth and into clivus
RE axial trocar clivus

Sagittal CT scan showing bone cement in the clivus and C-2 vertebral body
Bone cement filling the clivus and C-2 behind the pharynx

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