Devoted to diagnostic and interventional spine imaging and therapeutics


Transoral CT Guided C2 Procedures: Diagnostic yield improvement and therapeutic considerations 2012

Interventional Spine

Sudhir, Kathuria, MBBS, MD
James, Chen, MD, Non ASSR Member
Dheeraj, Gandhi, MBBS, MD, Non ASSR Member



Upper cervical spine traditionally poses difficulties in diagnostic and therapeutic interventions because of the proximity to vital vascular and neural structures. Unlike thoracic and lumbar spine, transpedicular approach is often not possible due to small pedicle size. Transoral approach to C2 lesions has been commonly used by surgeons and is well known to interventional radiologists. This is underutilized by interventional radiologists and there are only occasional small series and case reports of this approach. Largest reported series consists of only five cases with four biopsies and one vertebroplasty with diagnostic yield of 50%. We present our experience with twelve consecutive transoral diagnostic and therapeutic interventions from October 2008 to November 2011. To the best of our knowledge, this is the largest FNAC/Biopsy series, first series directly comparing diagnostic yield of FNAC and biopsy, and first report of combining tumor ablation with vertebroplasty using CT-Guidance transoral approach for C2 lesions.

Methods & Materials

This retrospective case series examines total ten consecutive patients with C2 lesions who underwent total twelve CT guided transoral interventional procedures from October 2008 to November 2011. Total nine patients underwent both FNAC (22 gauge needle) and core biopsy (16 gauge needle) procedure; one patient underwent only core biopsy and in addition, two of them also underwent combined tumor ablation/vertebroplasty for tumor related pain treatment. All procedures were performed under general anesthesia using CT guidance and were observed in the post-anesthesia care unit for two to three hours. Appropriate clinical follow up was obtained after that. The results of FNAC and Biopsy were compared.


Total nine FNAC, ten Biopsy (all nine patients with FNAC also had core biopsy), and two combined ablation/vertebroplasty procedures were performed in ten patients. All the FNAC, Biopsy, and therapeutic procedures in our series were technically successful with no procedural or post-procedural complications. Diagnostic yield of FNAC was only 55.6% compared to 100% yield of core biopsy. Both patients that underwent ablation and vertebroplasty procedure had significant pain relief following the procedure.


CT-guided transoral approach is safe and effective in performing both diagnostic and therapeutic interventions for C2 lesions. Diagnostic yield can be significantly improved by making effort to obtain core biopsy along with FNAC. Although visibly challenging, transoral approach is technically straightforward when performed with proper technique and appropriate precautions.