Fig. 2.

( a ) A 52-year-old woman with metastatic lung cancer and neck pain. Multidisciplinary decision making with spine surgeon determined surgical decompression and fusion would be optimal but complicated by poor bone quality and metastases. ( b, c ) Transoral approach to C2 body using nasal intubation, bite block, and 14-gauge bone trocar (arrow). ( d, e ) Vertebroplasty of C2 using polymethylmethacrylate (PMMA). Additional vertebroplasty was performed at C5 and C7 from an anterolateral approach using ultrasound guidance taking care to avoid critical vascular structures. ( f ) Five days later, the patient underwent surgical decompression and stabilization utilizing previously placed PMMA for screw augmentation.