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  • For cervical procedures, anterolateral approach is recommended. Transoral approach can be used for C2.
  • The cervical level can be approached without CT guidance under fluoroscopic monitoring. This procedure remains nevertheless difficult to perform under exclusive fluoroscopic guidance and unexperienced operators should use the more comfortable dual CT and fluoroscopy guidance.
  • For exclusive fluoroscopic guidance, the patient is placed in supine position, with a cushion under the lower neck and the upper thoracic spine in order to hyperextend the neck. After preparation of the skin and local anesthesia, the needle is inserted anterolateraly.

Fig. 1: For cervical procedures, anterolateral approach is recommended.

A15-gauge  vertebroplasty needle is inserted anterolateraly. During the insertion, the trachea and esophagus should be pushed to remove them from the pathway. The carotid artery is detected by its pulsation and avoided.