Percutaneous cement discoplasty for the treatment of lumbar degenerative diseases: A system review and meta-analysis.

BACKGROUND: Lumbar degenerative disease (LDD) is one of the main causes of low back pain in the elderly. Surgical treatment usually involves decompression surgery and fusion techniques; however, standard fusion surgery in elderly patients is associated with a higher rate of complications, hospital length of stay, and readmission. Although minimally invasive surgery can reduce risk and shorten hospital stays, it still cannot eliminate the inherent complications of fusion or internal fixation, especially in frail patients. Therefore, it is necessary to find a surgical technology that can not only reduce the risk of operation but also effectively reduce the inherent complications of fusion or internal fixation. The purpose of this study was to evaluate the clinical efficacy and feasibility of percutaneous cement discoplasty for the treatment of LDDs. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search strategy was conducted in PubMed, Web of Science, MEDLINE, Google Scholar, China National Knowledge Infrastructure, China Biology Medicine Disc, and Medical Knowledge Network Citation Database. The quality of the included study was assessed by the Methodological Index for Non-Randomized Studies (MINORS) score. The risk of bias (RoB) about the included study was assessed by the Non-Randomized Studies of Interventions (ROBINS-I) tool. The main results were summarized and analyzed in RevMan 5.4. RESULTS: Finally, we included 10 articles and collected a total of 359 patients, including 171 males (47.63%) and 180 females (52.37%), with an average age of 73.09 ±â€…2.74 years. The Methodological Index for Non-Randomized Studies (MINORS) tool was used to assess the articles included in this study, the methodological quality score of 10 retrospective studies varied from 7 to 11. The RoB was assessed using the ROBINS-I tool. Critical RoB was found in 4/10 articles, high RoB was found in 5/10 articles, and intermediate RoB was found in 1/10 articles. The study found that the Visual Analog Scale scores at 1 day (mean difference [MD]: 3.48; 95% confidence interval [CI]: 3.04, 3.93; I2 = 0%), 3 to 6 months (MD: 4.05; 95% CI: 3.53, 4.56; I2 = 65%), and 12 to 24 months (MD: 4.00; 95% CI: 3.53, 4.47; I2 = 45%) after operation were significantly different from those before operation. Meanwhile, the Oswestry Disability Index at 1 day (MD: 42.67; 95% CI: 36.78, 48.57; I2 = 76%), 3 to 6 months (MD: 42.64; 95% CI: 34.44, 50.83; I2 = 91%), and 12 to 24 months (MD: 49.22; 95% CI: 42.23, 56.22; I2 = 83 %) after operation were still significantly different from those before operation. The results with high heterogeneity (I2>50%) were analyzed by sensitivity analysis and subgroup analysis. The results still have significant statistical differences. CONCLUSION: Studies have shown that percutaneous cement discoplasty is a potential intervention for the treatment of LDDs, which can effectively relieve pain and improve dysfunction.

Effectiveness of RF ablation and cementoplasty in enhancing functional capacity in pelvic malignant bone metastases.

PURPOSE: Pelvic and sacral bone metastases cause significant morbidity. The primary aim of the study is to thoroughly evaluate the increase in functional capacity resulting from combined RF ablation and cementoplasty surgery applied to malignant bone metastases of the pelvic bones. METHODS: Twenty patients who underwent RF ablation and cementoplasty for malign pelvic bone and sacrum metastases between January 2014 and December 2021 were retrospectively identified. The inclusion criteria were having a life expectancy of more than 1 month, being > 18 years old, and having at least 1 month of follow-up. The Visual Anlogue Scale (VAS) pain, Karnofsky Performance Status (KP), and Musculoskelatal Tumor Society (MSTS) scores were calculated. RESULTS: VAS pain values decreased, and KP values increased postoperatively (p = 0.006 and p = 0,013). There was no statistically significant increase in MSTS (p > 0.05). The correlation relationships between lesion filling ratio and VAS pain, KP, and MSTS scores were not statistically significant (p > 0.05). Cement leakage was observed in 5 patients (25.0%), and no symptoms related to this leakage were observed. CONCLUSION: The pelvic region, given its close proximity to blood vessels, nerves, and joint areas, along with the distinct challenges associated with its surgery, requires separate evaluation. In studies evaluating applications in the isolated pelvic ring region, as in our study, functional gains have been most comprehensively assessed in this study, demonstrating that the procedure results in significant functional improvements.

Reconstruction with antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty for pediatric chest wall reconstruction: A 10-case series.

INTRODUCTION: Chest wall reconstruction in children after large resection of tumors may be performed with rigid or soft materials. Cementoplasty is commonly used with the "Sandwich" method i.e. gore-tex meshes surrounding both faces of the cement. HYPOTHESIS: Is antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty an interesting alternative to the double-side "sandwich" method for chest wall reconstruction? MATERIAL AND METHODS: Consecutive patients who were treated from 2011 to 2023 in our hospital were included. RESULTS: Among the ten children treated with a median 5.6 years follow-up, there were no surgical complications related to the reconstruction, loss of function, infections, post operative complications (versus 22.7% in meta-analysis encompassing the 50 rigid reconstructions reported worldwide) nor scoliosis (versus 25%). Three patients have an asymmetric chest wall appearance. DISCUSSION: "Tartine" cementoplasty is a simple, low-cost technique for pediatric chest wall reconstruction. It is well tolerated and checks key demands for chest wall reconstructions. LEVEL OF EVIDENCE: IV; retrospective case series.

Application of cementoplasty in patients with symptomatic benign osteopathy disease.

BACKGROUND: The optimal treatment for some symptomatic, benign osteopathy lesions is yet to be identified. PURPOSE: To investigate the clinical efficiency of cementoplasty in managing symptomatic, benign osteopathy. MATERIAL AND METHODS: Between June 2006 and January 2020, we retrospectively enrolled 31 patients (10 men, 21 women; mean age = 46.5 ± 16.6 years; age range = 20-85 years), accounting for 34 treatment sites, who underwent percutaneous osteoplasty (14 treatment sites) and percutaneous vertebroplasty (20 treatment sites) with digital subtraction angiography (DSA) or DSA combined with computed tomography (CT). All the participants experienced different degrees of clinical symptoms with benign osteopathy lesions. The technical success of the procedure and occurrence of complications were recorded. Follow-up examinations were conducted to assess the treatment outcome using the MacNab criteria. RESULTS: All the participants had a diagnosis of benign osteopathy lesions before or after the cementoplasty. Surgery was successfully completed in all patients. Cement distributions were diffuse and homogeneous, with the complication of cement leakage occurring in 17.6% (6 of 34) of the lesions. The leakage occurred in the intervertebral disc (n = 1), the intra-articular space (n = 1), and the surrounding soft tissue (n = 4). Analysis of the treatment outcome using the MacNab criteria revealed that all patients showed improvement in their clinical symptoms to some extent and in the quality of life. CONCLUSION: Cementoplasty is an effective treatment for symptomatic, benign osteopathy, with the advantage of favorable clinical outcomes, and low complication rate.

Bone Consolidation: A Practical Guide for the Interventional Radiologist.

In recent years, interventional radiologists have been increasingly involved in the management of bone fractures resulting from benign (osteoporosis and trauma), as well as malignant (tumor-related impending or pathologic fractures) conditions. Interventional techniques used to fix fractures include image-guided osteoplasty, screw-mediated osteosynthesis, or combinations of both. In the present narrative review, we highlight the most common clinical scenarios that may benefit from such interventional techniques with specific focus on spine, pelvic ring, and long bones.

Initial experience, feasibility, and technical development with an electromagnetic navigation assistance in percutaneous pelvic bone cementoplasty: retrospective analysis.

OBJECTIVES: To assess the feasibility and technical outcomes of pelvic bone cementoplasty using an electromagnetic navigation system (EMNS) in standard practice. MATERIALS AND METHODS: Monocentric retrospective study of all consecutive patients treated with cementoplasty or reinforced cementoplasty of the pelvic bone with EMNS-assisted procedures. The endpoints were periprocedural adverse events, needle repositioning rates, procedure duration, and radiation exposure. RESULTS: A detailed description of the technical steps is provided. Thirty-three patients (68 years ± 10) were treated between February 2016 and February 2020. Needle repositioning was required for 1/33 patients (3%). The main minor technical adverse event was soft tissue PMMA cement leaks. No major adverse event was noted. The median number of CT acquisitions throughout the procedures was 4 (range: 2 to 8). Radiation exposure and mean procedure duration are provided. CONCLUSION: Electromagnetic navigation system-assisted percutaneous interventions for the pelvic bone are feasible and lead to low rates of minor technical adverse events and needle repositioning. Procedure duration and radiation exposure were low. KEY POINTS: • Initial experience for 33 patients treated with an electromagnetic navigation assistance for pelvic cementoplasty shows feasibility and safety. • The use of an electromagnetic navigation system does not expose to high procedure duration or radiation exposure. • The system is efficient in assisting the radiologist for extra-axial planes in challenging approaches.

Safety and Feasibility of Steerable Radiofrequency Ablation in Combination with Cementoplasty for the Treatment of Large Extraspinal Bone Metastases.

Background: Radiofrequency ablation (RFA) and cementoplasty, individually and in concert, has been adopted as palliative interventional strategies to reduce pain caused by bone metastases and prevent skeletal related events. We aim to evaluate the feasibility and safety of a steerable RFA device with an articulating bipolar extensible electrode for the treatment of extraspinal bone metastases. Methods: All data were retrospectively reviewed. All the ablation procedures were performed using a steerable RFA device (STAR, Merit Medical Systems, Inc., South Jordan, UT, USA). The pain was assessed with a VAS score before treatment and at 1-week and 3-, 6-, and 12-month follow-up. The Functional Mobility Scale (FMS) was recorded preoperatively and 1 month after the treatment through a four-point scale (4, bedridden; 3, use of wheelchair; 2, limited painful ambulation; 1, normal ambulation). Technical success was defined as successful intraoperative ablation and cementoplasty without major complications. Results: A statistically significant reduction of the median VAS score before treatment and 1 week after RFA and cementoplasty was observed (p < 0.001). A total of 6/7 patients who used a wheelchair reported normal ambulation 1 month after treatment. All patients with limited painful ambulation reported normal ambulation after the RFA and cementoplasty (p = 0.003). Technical success was achieved in all the combined procedures. Two cement leakages were reported. No local recurrences were observed after 1 year. Conclusions: The combined treatment of RFA with a steerable device and cementoplasty is a safe, feasible, and promising clinical option for the management of painful bone metastases, challenging for morphology and location, resulting in an improvement of the quality of life of patients.

Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review.

Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients' quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.

Combination of Percutaneous Screw Fixation and Cementoplasty for Lytic Bone Metastases: Feasibility, Safety and Clinical Outcomes.

OBJECTIVE: To evaluate feasibility, safety and efficacy of a combination of screw fixation and cementoplasty for pathologic bone fracture. METHODS: In this single-center prospective study, all consecutive percutaneous screw fixations under assisted CT guidance for palliation and fracture treatment of pathologic bone fracture were reviewed from July 2019 to February 2021. The primary outcome measure was the procedures' technical success, defined as the correct placement of the screw(s), without any complications. Secondary outcome measures were the safety, the procedures' early analgesic effects and impacts on quality of life at 4 weeks. RESULTS: Technical success was achieved in 11/11 procedures (100%) among 11 patients. No major complications attributable to the procedure were noted. The mean pain scored significantly decreased at the initial follow-up: 8.0 ± 2.7 versus 1.6 ± 2.5 (p < 0.05). Opioid doses were statistically lower after procedure: 70.9 ± 37 versus 48.2 ± 46 mg/day (p < 0.05). The mean EQ5D score had significantly increased by the early post-procedure consultation: 42.5 ± 13.6 vs 63.6 ± 10.3 (p < 0.05). CONCLUSION: Combination of percutaneous screw fixation and cementoplasty for pathologic bone fracture is feasible and safe. It is efficient to reduce pain, decrease the consumption of opioids and improve the quality of life at 4 weeks after the procedure.

Extraction of cement leakages and malpositioned spindles complicating percutaneous interventions: why, when and how?

OBJECTIVES: Cement leakages in soft tissues are a common occurrence during cementoplasty. They may cause chronic pain, and thus treatment failure. Spindle malposition during reinforced cementoplasty may cause vascular, nerve or cartilage injury. Our goal was to evaluate the rate of cement leakage/spindle extraction and describe the techniques used. METHODS: This retrospective monocentre study included 104 patients who underwent reinforced cementoplasty and 3425 patients who underwent cementoplasty between 2012 and 2020. Operative reports and fluoroscopic images were reviewed to identify extraction attempts and their outcomes. RESULTS: Six patients (5.8%) had a malpositioned spindle, and all of them underwent spindle extraction during reinforced cementoplasty, with an 80% success rate. A total of 7 attempts were performed, using 2 different techniques. One thousand one hundred thirty patients (32%) had a cement leak in soft tissues, and 7 (0.6%) underwent cement leakage extraction during cementoplasty, with a 100% success rate. A total of 10 attempts were performed, using 3 different techniques. No major complication related to the extraction procedures occurred. CONCLUSIONS: Spindle malpositions and soft tissue cement leakages are not uncommon. We described 5 different percutaneous techniques that were safe and effective to extract spindles and paravertebral cement fragments. KEY POINTS: • Soft tissue cement leakages or spindle malpositions are a non-rare occurrence during cementoplasty, and may cause technical failure and/or chronic pain. • Most soft tissue cement fragments and malpositioned spindles can easily be extracted using simple percutaneous techniques.

Reinforced cementoplasty for pelvic tumour lesions and pelvic traumatic fractures: preliminary experience.

OBJECTIVES: Pelvic bone pathological lesions and traumatic fractures are a considerable source of pain and disability. In this study, we sought to evaluate the effectiveness of reinforced cementoplasty (RC) in painful and unstable lesions involving the pelvic bone in terms of pain relief and functional recovery. METHODS: All patients with neoplastic lesion or pelvic fracture for whom a pelvic bone RC was carried out between November 2013 and October 2017 were included in our study. All patients who failed the medical management, patients unsuitable for surgery, and patients with unstable osteolytic lesions were eligible to RC. Clinical outcome was evaluated with a 1-month and 6-month post-procedure follow-up. The primary endpoint was local pain relief measured by the visual analogue scale (VAS). RESULTS: Twenty-two patients (18 females, 4 males; mean age of 65.4 ± 13.3 years [range 38-80]) presenting with painful and unstable pelvic lesions were treated by RC during the study period. Among the 22 patients, 8 patients presented with unstable pelvic fractures (3 patients with iliac crest fracture, 3 with sacral fractures, and the remaining 2 with peri-acetabular fractures). No procedure-related complications were recorded. All patients had significant pain relief and functional improvement at 1 month. One patient (4.5%) had suffered a secondary fracture due to local tumour progression. CONCLUSIONS: Reinforced cementoplasty is an original minimally invasive technique that may help in providing pain relief and effective bone stability for neoplastic and traumatic lesions involving the pelvic bone. KEY POINTS: • Reinforced cementoplasty is feasible in both traumatic fractures and tumoural bone lesions of the pelvis. • Reinforced cementoplasty for pelvic bone lesions provides pain relief and functional recovery. • Recurrence of pelvic bone fracture was observed in 4.5% of the cases in our series.

Avoiding complications in percutaneous osteoplasty.

Percutaneous osteoplasty techniques include cement injection either solely performed or in combination to hardware such as cannulated screws, peek implants or other metallic hardware including micro-needles and Kirschner wires. Depending on bone and local forces applied, fracture and osseous defect characteristics as well as symptoms and operator's preference percutaneous osteoplasty techniques include cementoplasty, fixation by internal cemented screw and augmented osteoplasty. Literature data support efficacy and safety of these techniques, focusing mainly on the minimal invasive nature of these approaches along with minimum overall morbidity and mortality and an impressive pain reduction effect. Percutaneous osteoplasty techniques in the peripheral skeleton are indicated for pain palliation or for prevention of impeding pathologic fractures. Although safe, osteoplasty techniques are not without risk of complications and adverse events. Complications are classified based either upon clinical impact or timing of occurrence; complications' reviewing and grading should be performed on terms of a uniform and accurate reproducible and validated categorization system. Significant factors for avoiding complications in percutaneous osteoplasty techniques include proper training, patient- and lesion-tailored approach, high-quality imaging guidance, sterility as well as appropriate selection of technique and materials. The present article reports the possible complications of percutaneous osteoplasty techniques and reviews the prerequisites necessary for avoiding and managing these adverse events.

Patient's Selection and Evaluation for Bone Stabilization.

Bone stabilization procedures performed by Interventional Radiologists have significantly increased in the past ten years with a wide variety of techniques available ranging from cementoplasty to complex combined treatment associating thermoablation, cementoplasty and fixation. Many available manuscripts and reviews focus on the technical aspects, feasibility and outcomes of these procedures. However, not every procedure is suitable for every patient, and therefore selecting a patient for a specific procedure represents the first necessary step to a successful procedure. This review will describe every step of the selection process which the Interventional Radiologists is confronted with prior to performing a consolidation procedure in the setting of bone cancer. Defining the clinical setting is mandatory and includes assessing the patient's clinical status, cancer stage, level of pain and disability will help define the objective of the procedure: curative, palliative intent. A thorough imaging assessment is also mandatory, as it will define the type of consolidation (cementoplasty or fixation) which will be performed depending on the anatomical location and size of the lesion, the type of stresses at stake (compression or shear) and it will help plan the needle pathway and assess for possible complications. The process of selecting a patient for a specific procedure should be performed by the Interventional Radiologist but should be validated in a multidisciplinary approach. Moreover, the objective of a procedure, including the expected outcome and possible adverse events and complications should clearly be explained to the patient.

Image guided procedures to stabilize the pelvic girdle in cancer patients.

With the advancement of oncologic treatments, advanced cancer patients with bone involvement survive longer. Cancer involving weight-bearing bones of pelvic girdle results in mechanical pain that interferes with ambulation, deteriorates quality of life, and causes serious complications that may accelerate their demise. Among common treatments for bone metastases, radiation therapy does not reinforce bone and surgical fixation is often complex with high risks of complications and may not be possible due to comorbidities in this patient population. Image guided percutaneous stabilization techniques have been proven as viable options in this setting.

Percutaneous Fixation of Impending Fracture of the Hip.

According to the literature, prophylactic consolidation of proximal femur lytic metastasis the is recommended when the Mirels' score is above 8. Osteoplasty (cementoplasty of proximal femur) alone provides inadequate consolidation. Various mini-invasive technics, augmented osteoplasties, have been proposed for better long-term consolidation. The aim of this review is to detail the augmented osteoplasty techniques described in the literature and to report their safeties and efficacies to prevent pathological fracture of the proximal femur. A PubMed research found 8 studies that evaluated augmented osteoplasty of the proximal femur in cancer patients. All devices demonstrate adequate safety and low rate of secondary pathological fractures.

Local Control of Cancers With Various Ablation Techniques.

Metastatic disease to the bone and soft tissue creates significant morbidity because of pain resulting in decreased functional status. Palliative chemotherapy and radiation therapy were historically the mainstays of pain reduction. Minimally invasive technologies such as image-guided ablation and cementoplasty have become common in interventional radiology. Advances in image guidance and ablation technologies have improved the multidisciplinary approach in the management of bone and soft-tissue disease. The minimally invasive nature of the interventions allows prompt initiation or continuation of chemotherapy and radiation therapy. These safe and efficacious procedures have improved patient quality of life by decreasing pain and improving function.

Percutaneous Cement Discoplasty for Degenerative Low Back Pain with Vacuum Phenomenon: A Multicentric Study with a Minimum of 2 Years of Follow-Up.

BACKGROUND: To report clinical results after percutaneous cement discoplasty (PCD) in a multicentric case series with a minimum of 2 years of follow-up. METHODS: Between December 2014 and January 2019, 180 patients with low back pain and advanced degeneration were treated with percutaneous discoplasty in 2 centers. The inclusion criteria were as follows: patients 65 years or older, with mechanical low back pain with or without spinal stenosis, who did not respond to conservative management. Patients were divided into 3 groups: group 1: patients without previous spine surgeries who underwent PCD, group 2: patients with previous spine surgeries who underwent PCD, and group 3: patients with/without previous surgery who underwent PCD plus decompression surgery. Clinical and radiological analyses were performed as well as complication and readmission rates. RESULTS: A total of 156 patients (74% female; mean age, 75.8 ± 5.7 years; mean body mass index, 29.9 ± 5.2) were included in our study. Overall preoperative visual analog score (VAS) and Oswestry Disability Index (ODI) were 7.8 ± 0.9 and 68.1 ± 9.6, respectively. At 2 years of follow-up, mean VAS improvement was 3.56 (95% confidence interval: 3.92-3.20; P < 0.0001) and mean ODI improvement was 17.18 (95% confidence interval: 19.52-14.85; P < 0.0001), showing a significant and sustained improvement in both scores. In addition, 84% of patients reached both VAS and ODI minimum important clinical difference at the final follow-up. Finally, 5.7% of patients suffered major complications 30 days postoperatively. CONCLUSIONS: PCD showed significant improvement of VAS and ODI scores at 2 years of follow-up with relatively low rate of complications.

Navigation-guided percutaneous pelvic cementoplasty for metastatic bone pain: A case report.

RATIONALE: Percutaneous cementoplasty is a minimally invasive procedure that can provide immediate pain relief and improve range of motion in patients with metastatic bone pain. Conventionally, this procedure is guided by computed tomography (CT). However, to minimize exposure to radiation, we performed percutaneous cementoplasty under the guidance of a navigation system. PATIENT CONCERNS: A 60-year-old man presented with left hip pain for several months due to bone metastasis in the left ilium. DIAGNOSES: The patient was diagnosed with lung cancer and multiple bone metastases including ileum. INTERVENTIONS: The puncture needle was placed under the guidance of a navigation system with pre-procedure CT images, and bone cement was injected into the osteolytic lesion in the left ilium. OUTCOMES: Bone cement placement was confirmed by post-procedure radiography, and its distribution was satisfactory. The patient's Karnofsky Performance Scale and Brief Pain Inventory scores showed improvement in pain and mobility without complications. LESSONS: Percutaneous cementoplasty guided by a navigation system is a safer and more effective method with less radiation compared with conventional CT-guided methods.

Toward Biofabrication of Resorbable Implants Consisting of a Calcium Phosphate Cement and Fibrin-A Characterization In Vitro and In Vivo.

Cleft alveolar bone defects can be treated potentially with tissue engineered bone grafts. Herein, we developed novel biphasic bone constructs consisting of two clinically certified materials, a calcium phosphate cement (CPC) and a fibrin gel that were biofabricated using 3D plotting. The fibrin gel was loaded with mesenchymal stromal cells (MSC) derived from bone marrow. Firstly, the degradation of fibrin as well as the behavior of cells in the biphasic system were evaluated in vitro. Fibrin degraded quickly in presence of MSC. Our results showed that the plotted CPC structure acted slightly stabilizing for the fibrin gel. However, with passing time and fibrin degradation, MSC migrated to the CPC surface. Thus, the fibrin gel could be identified as cell delivery system. A pilot study in vivo was conducted in artificial craniofacial defects in Lewis rats. Ongoing bone formation could be evidenced over 12 weeks but the biphasic constructs were not completely osseous integrated. Nevertheless, our results show that the combination of 3D plotted CPC constructs and fibrin as suitable cell delivery system enables the fabrication of novel regenerative implants for the treatment of alveolar bone defects.

Percutaneous Image-Guided Anterior Screw Fixation of the Odontoid Process.

PURPOSE: To describe the technique of percutaneous image-guided anterior screw fixation of the odontoid process in five patients using hydrodissection of the jugulo-carotid and pre-vertebral spaces. METHODS AND MATERIALS: Between 03/2018 and 03/2020, five patients from two university hospitals underwent a percutaneous image-guided anterior screw fixation of the odontoid process for one pathological fracture, two impending fractures and two traumatic fractures of the dens. Technical success was defined as a satisfactory positioning of the screw in the odontoid. Detailed data with the number and type of needles required, the time to perform hydrodissection, the volume of fluid used, the time for bone access, the size and lengths of the screws used, technical success, complications, clinical outcomes and follow-up were retrospectively assessed. RESULTS: Technical success was achieved in 100% (5/5 cases), with a mean volume of hydrodissection of 218 ± 8.4 mL (range 210-230). Mean total procedure time was 112 ± 34 min (range 70-160). The lengths of the screws ranged from 30 mm to 55 mm. Additional cementoplasty was performed in the three malignant cases. VAS scores dropped on a 10-point scale from mean 5.8 ± 2.2 pre-procedure to 0.8 ± 0.4 after the procedure. No major complication occurred. CONCLUSION: Percutaneous image-guided anterior screw fixation of the odontoid process using hydrodissection of the jugulo-carotid and pre-vertebral spaces is technically feasible and seems safe.