Transoral vertebral augmentation with polymethylmethacrylate in the treatment of a patient with a dens fracture nonunion and subarticular vertebral body fracture of C2

The injection of polymethylmethacrylate (PMMA) is a minimally invasive, image-guided procedure used to treat vertebral fractures due to osteoporosis, metastatic lesions, multiple myeloma, and benign but destabilizing bone tumors. The injection of PMMA into the C2 vertebral body using the transoral technique has been reported in three separate patients for treatment of benign tumors (a vertebral hemangioma and an aneurysmal bone cyst) and for multiple myeloma in the third patient. Although the injection of PMMA into the vertebral body is most commonly performed to treat benign vertebral compression fractures, a transoral C2 approach has not been reported in the English literature as a treatment for a benign fracture of C2. We report the treatment of a fracture and nonunion of the base of the dens and a subarticular fracture of the vertebral body of C2 using a bilateral transoral approach.