Primary amyloidoma of the thoracic spine

Amyloidoma is a nodular mass of amyloid with no evidence of generalized amyloidosis. Primary amyloidoma of the spine is very rare and has a predilection for the thoracic region. The tumor-like appearance and behavior make it difficult to diagnose on imaging studies. Despite its rarity and nonspecific radiologic findings, primary spinal amyloidoma should be included in the differential diagnosis of an osteolytic and calcified mass of the spine. We report the case of a 38-year-old woman with amyloidoma involving the thoracic spine and describe the main characteristics of this condition.     

Primary amyloidoma of the thoracic spine presenting with acute paraplegia

BACKGROUND

Primary solitary amyloidoma of the spine is a rare disease characterized by localized deposition of amyloid. To the best of our knowledge, there have been only 14 cases previously reported in the literature. Patients with focal spinal amyloidoma usually have relatively long symptomatic periods preoperatively, ranging from 3 weeks to 6 years (mean: 12 months). Only two reported patients had acute paraplegia. We add a third case of a thoracic spine amyloidoma presenting with acute paraplegia.

CASE DESCRIPTION

A 65-year-old man presented with a three-day history of progressive paraplegia and urinary retention. He was found to have severe cord compression at T2 on magnetic resonance imaging. He underwent emergent decompressive laminectomy with instrumentation for spinal stabilization. Histopathology revealed abundant amyloid deposits. A systemic work-up was negative for amyloidosis. The patient showed marked neurological improvement with residual mild spastic gait after 1 year.

CONCLUSIONS

Primary spinal amyloidoma with acute paraplegia is rare. One-stage surgery combining prompt decompression and stabilization of the spinal column is mandatory in cases of spinal amyloidoma with acute myelopathy, because primary solitary amyloidoma carries a good prognosis.     

Primary amyloidoma of the axis and acute spinal cord compression: a case report

Background Localized primary amyloidosis is a disease characterized by a single tumor and localized amyloid deposit (amyloidoma) with no evidence of generalized amyloidosis. The occurrence of an amyloidoma in the spine is rare and only three cases affecting the axis have been previously reported. We describe the case of a 79-year-old woman presenting with a mass involving the odontoid process, responsible for an acute tetraparesia. Diagnosis of local primary amyloidosis was made after surgical excision.Results Despite the critical presentation, outcome was excellent after total excision of the mass. This case can be classified as a primary localized amyloidoma. The patient did not exhibit any infection, tumor or inflammatory disease, and continued investigations failed to demonstrate other amyloid deposit after one-year follow-up.Conclusions Amyloidoma must be discussed in presence of a tumor-like mass of the odontoid process and may be responsible, as in our case, for spinal cord compression.     

Multiple myeloma-associated solitary epidural amyloidoma of C2-C3 without bony connection or myelopathy: case report and review of the literature

BACKGROUND: A large solitary amyloidoma in the cervical epidural space without bony connection and with minimal spinal cord compression and no myelopathy, as a first manifestation of disseminated amyloidosis in a multiple myeloma patient, has not been reported previously; this case is thereby distinct from the seven prior reports in the world literature, of a solitary amyloidoma of the cervical spine. CASE DESCRIPTION: A 72-year-old male, recently diagnosed with multiple myeloma, presented with a neuropathy that prompted a screening MRI of the cervical spine. This disclosed a large mass in the upper cervical epidural area felt to pose a high morbidity/mortality risk, leading to successful surgical removal of the amyloidoma mass. This then led to further testing that showed previously unsuspected widespread amyloidosis, which was subclinical up to that time. CONCLUSIONS: In patients with a newly discovered amyloidoma, whether or not in the setting of known multiple myeloma, further evaluation should be done to detect the presence of amyloidosis. If the mass is discovered de novo, then an investigation should be carried out to determine if multiple myeloma, as well as amyloidosis, is present.     

Primary amyloidoma of the thoracic spine causing paraparesis

A 52-year-old lady presented with progressive paraparesis. MRI revealed collapse of D9 vertebrae which was infiltrated by a low signal lesion both on T1 and T2. She underwent vertebrectomy and insertion of moss cage. The histology came back as amyloidoma. The presentation, investigation and management of primary amyloidoma of the spine is discussed along with a review of the literature.     

Primary cervical amyloidoma: a case report and review of the literature

Background context

Primary solitary amyloidosis or amyloidoma is a disease process characterized by the focal deposition of amyloid in the absence of a plasma cell dyscrasia with normal serum protein measurements. Solitary amyloidomas affecting the vertebrae are very uncommon but typically affect the thoracic spine. Primary cervical amyloidosis is an exceedingly rare entity with exceptionally good prognosis, but requires diligence of the treating physician to establish the diagnosis and implement the appropriate surgical intervention.

Purpose

This study aimed to present a rare case of primary cervical amyloidosis with long-term follow-up and review the clinical presentation, characteristic imaging findings, diagnostic pathology, differential diagnosis, treatment algorithm, and prognosis of the disease entity. This case demonstrates the progressive resorption of the amyloidoma over time after surgical stabilization. Previous reported cases of primary cervical amyloidosis will also be reviewed.

Study design

This study is a report and review of the literature.

Methods

A 77-year-old woman presented with a several-week history of gradual progressive weakness in her upper and lower extremities. Computed tomography and magnetic resonance imaging demonstrated a retro-odontoid nonenhancing soft-tissue mass, with erosive bony changes and severe mass effect on the upper cervical cord. The patient was taken to the operating room for decompression and posterior spinal stabilization.

Results

Intraoperative tissue specimens demonstrated amyloidosis and extensive systemic workup did not reveal any inflammatory processes, systemic amyloidosis, or plasma cell dyscrasia. Postoperatively, the patient regained full strength and ambulatory status. The patient remains asymptomatic at a 2-year follow-up. A postoperative follow-up magnetic resonance imaging demonstrated complete resorption of the residual amyloidoma.

Conclusions

Primary solitary amyloidosis is a rare form of amyloidosis that is important to differentiate given its excellent prognosis with surgical management. Treatment should include surgical decompression and spinal stabilization. This is the first case report to clinically and radiographically demonstrate the progressive resorption of a primary amyloidoma over time after surgical stabilization in the upper cervical spine. It is imperative that surgeons encountering such lesions maintain a high suspicion for this rare disease entity and advise their pathologists accordingly to establish the correct diagnosis.     

Giant-cell tumor of the tendon sheath involving the thoracic spine

Giant-cell tumor of the tendon sheath is a common benign lesion of the synovial membrane that frequently occurs in the hand. It is related to pigmented villonodular synovitis and the occurrence of pigmented villonodular synovitis or giant-cell tumor of the tendon sheath in the axial skeleton is very rare. To data, only three cases of giant-cell tumor of the tendon sheath involving cervical spine have been reported, compared with 26 cases of pigmented villonodular synovitis. Pigmented villonodular synovitis involving the thoracic spine is also extremely rare and our case represents the first reported case of a giant-cell tumor of the tendon sheath involving the thoracic spine. A 26-year-old man presented with left back pain without neurological deficit. Computed tomography and magnetic resonance imaging (MRI) revealed an osteolytic and expansive lesion in the left facet joint between the seventh and eighth thoracic vertebrae. A complete facetectomy and excision of the lesion followed by a posterior arthrodesis between Th5 and Th9 was performed. Postoperatively, the patient recovered with complete relief of symptoms, there was no evidence of recurrent disease or regrowth of the residual lesion, as investigated by plain radiographs and MRI within a follow-up period of two years. Although giant-cell tumor of the tendon sheath in the thoracic spine may be extremely uncommon, it should be considered in the differential diagnosis, especially when a benign lesion appears to originate in the face joint. Considering the high rate of recurrence, every effort should be made to achieve total excision.     

Primary amyloidoma in epidural and paravertebral space of the lumbar spine

Background context

Localized amyloid deposits result in a mass, that is, so-called amyloidoma; it has been reported in every anatomic site, although systemic amyloid deposition is much more common. However, primary lumbar epidural amyloidoma without bony involvement is extremely rare. To the best of our knowledge, only one case has been reported previously.

Purpose

To report and review the clinical presentations, imaging studies, and treatment of epidural and paravertebral amyloidoma.

Study design

A case report and review of the literature.

Methods

Lumbar epidural and paravertebral amyloidoma in a 75-year-old man with neurologic compromise is presented. Laminectomy with mass resection was performed.

Results

After surgery, almost complete neurologic improvement was observed. Histologically, definite diagnosis was obtained only after the specific staining of tissue. No sign of local recurrence was evident 1 year after surgery.

Conclusions

Primary amyloidoma, although rare, should be included in the differential diagnosis of epidural mass of the spine. Diagnosis before surgery is difficult as there were no characteristic findings in clinical and imaging studies. Special histologic technique and stains are useful to make a definite diagnosis.     

Benign fibrous histiocytoma of the thoracic spine: case report and review of the literature

Benign fibrous histiocytoma (BFH) is a rare skeletal tumor, accounting for approximately 1% of all surgically managed benign bone tumors. Spinal location is very rare, and its management can be challenging, involving excision of tumor and spinal reconstruction and stabilization. The prognosis is good after treatment. The authors present the case of BFH involving the thoracic spine and a review of the literature concerning BFH of the spine.     

上胸椎椎弓根螺钉固定并发症的探讨

目的分析上胸椎椎弓根螺钉固定的并发症,总结其手术技巧和经验。方法回顾性分析2009年4月至2012年4月采用T1~4椎弓根螺钉技术治疗的各类上胸椎损伤68例(共384枚螺钉),上胸椎骨折/脱位45例,均行Ⅰ期后路切开复位内固定术;结核合并后凸畸形23例,均行前路病灶清除植骨融合内固定术+后路矫形术。所有患者结合术中胸椎椎弓根四壁探查、术后手术节段椎体X线片、CT扫描,观察螺钉在椎弓根内的位置、角度及与椎弓根壁的关系和距离。结果椎弓根壁损伤54枚(14.06%),其中外侧壁损伤39枚(10.16%),包括Ⅰ级损伤27枚(7.03%),Ⅱ级损伤12枚(3.12%);内侧壁损伤15枚,均为Ⅰ级损伤。无1枚螺钉损伤上下壁,无1枚螺钉同时损伤超过2个壁,无术中置钉失败,螺钉松动位移2枚,创伤患者Frankel分级无加重,非创伤患者脊髓功能JOA评分由术前的5.9分提高至术后的11.5分,未发现植骨不融合、假关节形成或节段不稳表现。结论上胸椎椎弓根螺钉固定的并发症发生率低,是相对安全的操作方法。术前详细分析影像学资料、熟悉局部解剖特点、掌握合理的置钉技术,可有效避免并发症的发生。     

Transdiaphragmatic amyloidoma

The term "amyloidoma" has been used to describe localized pulmonary nodular amyloidosis when it is a solitary lesion. Amyloidoma is an uncommon and infrequently reported cause of benign pulmonary lesions. We report the case of a 45-year-old man with hemoptysis, eosinophilia, and a large mass involving both lobes of the left lung, the chest wall, and, via extension through the diaphragm, the liver. Clinical suspicion of echinococcal cyst led to treatment via en bloc excision rather than attempting tissue biopsy for diagnosis. Complete resection of the isolated pulmonary amyloidoma was achieved with no evidence of recurrence.     

Chordomas of the upper cervical spine: radiographic evaluation. Study of two cases and review of the literature

Chordomas are rare bony tumors, usually involving the skull base and sacrococcygeal spine, while least presented in cervical and thoracic spine. Chordomas of the cervical spine may cause variable neurological symptoms. Adult patients presenting with neck pain, paresthesias or limb paresis are further investigated. The history of progressive tetraparesis, however, implies a long-standing disease. Clinical presentation and imaging investigation of the cervical spine chordoma aims to alert the physicians for its early detection. Herein is reported the clinical presentation of two chordomas with progressive tetraparesis in two patients involving in both cases the third cervical vertebra. Plain radiographs, bone scintigraphy, CT and MR scanning were the imaging modalities depicting the mass, its prevertebral and intraspinal extension.     

Injury to the spinal cord without radiological abnormality (SCIWORA) in adults

Injury to the spinal cord without radiological abnormality often occurs in the skeletally immature cervical and thoracic spine. We describe four adult patients with this diagnosis involving the cervical spine with resultant quadriparesis. The relevant literature is reviewed. The implications for initial management of the injury, the role of MRI and the need for a high index of suspicion are highlighted.     

Thoracic aortic pseudoaneurysm after spine trauma in ankylosing spondylitis. Case report

Ankylosing spondylitis (AS) is a rheumatic disease characterized by consolidation of the articulating surfaces and inflammation of the vertebral column. Because of its associated spine stiffness and secondary osteoporosis, patients with this disorder are at increased risk of vertebral fractures. Ankylosing spondylitis presents a significant challenge to spine surgeons because of its complex effects on the spine, extraarticular organ manifestations, and potential neurological and functional sequelae. Traumatic thoracic and lumbar spine injuries in this patient population may be associated with injury to the aorta either due to direct mechanical trauma or to blunt forces associated with the spine fracture. This complication and association is thought to be the result of pathophysiological changes that cause the aorta to become firmly adherent to the anterior longitudinal ligament. The authors present a case of AS in a patient with a thoracic spine fracture and in whom a delayed thoracic aortic pseudoaneurysm ruptured. To the best of the authors' knowledge, only five cases of this complex condition have been reported since 1980. Recognition of the potential for aortic injury in patients with AS should prompt early investigation of the aorta in cases involving numerous fractures and assist in surgical planning to avoid this lethal injury.     

Normal and abnormal spine and thoracic cage development

Development of the spine and thoracic cage consists of a complex series of events involving multiple metabolic processes, genes and signaling pathways. During growth, complex phenomena occur in rapid succession. This succession of events, this establishment of elements, is programmed according to a hierarchy. These events are well synchronized to maintain harmonious limb, spine and thoracic cage relationships, as growth in the various body segments does not occur simultaneously at the same magnitude or rate. In most severe cases of untreated progressive early-onset spinal deformities, respiratory insufficiency and pulmonary and cardiac hypertension (cor pulmonale), which characterize thoracic insufficiency syndrome (TIS), can develop, sometimes leading to death. TIS is the inability of the thorax to ensure normal breathing. This clinical condition can be linked to costo-vertebral malformations (e.g., fused ribs, hemivertebrae, congenital bars), neuromuscular diseases (e.g., expiratory congenital hypotonia), Jeune or Jarcho-Levin syndromes or to 50% to 75% fusion of the thoracic spine before seven years of age. Complex spinal deformities alter normal growth plate development, and vertebral bodies become progressively distorted, perpetuating the disorder. Therefore, many scoliotic deformities can become growth plate disorders over time. This review aims to provide a comprehensive review of how spinal deformities can affect normal spine and thoracic cage growth. Previous conceptualizations are integrated with more recent scientific data to provide a better understanding of both normal and abnormal spine and thoracic cage growth.     

Multifocal extensive spinal tuberculosis (Pott's disease) involving cervical, thoracic and lumbar vertebrae

An unusual case is reported of a 53-year-old woman presenting with spinal tuberculosis involving cervical, thoracic and lumbar vertebrae. The patient originally presented with progressive quadriparesis, fever, night sweats and weight loss. Imaging studies demonstrated vertebral body destruction with and without paraspinal and/or intraspinal abscess in cervical, thoracic and lumbar regions. The laboratory studies confirmed the diagnosis of Pott's disease and the patient was placed on anti-tuberculosis chemotherapy. The anterior approach was used for removal of the infected necrotic material, bone grafting and instrumentation, in both cervical and thoracic vertebrae. The postoperative course was uneventful and the patient made an excellent neurological recovery. The present report is of the first published case of an extensive spinal tuberculosis involving cervical, thoracic and lumbar spine.     

Complications of sublaminar wiring

Complications of sublaminar wiring are reported, including four cases that involved the cervical spine and one case that included the thoracolumbar spine. The complication rate at our institution involving the cervical spine was about 7% and less than 1% for the thoracic spine. A direct correlation exists between the degree of anterior bowing, number of consecutive laminae the wire passes beneath, and the complication rate. The clinical presentations, radiologic findings, and indications for surgical removal of the wires are discussed. To our knowledge, nothing has been reported in the literature regarding the complications caused by sublaminar wiring of consecutive vertebrae.     

Image-guided multilevel vertebral osteotomies for en bloc resection of giant cell tumor of the thoracic spine: case report and description of operative technique

The use of frameless stereotactic navigation is gaining popularity in spinal surgery. Although initially used in the spine for placement of lumbar pedicle screws, this technology has expanded to facilitate placement of spinal instrumentation at virtually all spinal levels. While previous reports have described the utility of image guidance for placement of spinal instrumentation, its use in assisting with resection of complex spine tumors has not been extensively reported. Here we describe the use of frameless stereotaxy to guide a complex, four-level sagittal vertebral osteotomy for en bloc resection of a giant cell tumor involving the chest wall and thoracic spine.     

Le complicanze vascolonervose nella chirurgia della colonna toracica

The incidence of complications in thoracic spine surgery is high. Retrospective reviews underestimate the number of complications in thoracic spine surgery. The main complications are vascular or neurological injuries during pedicular screws placement, during traction and reduction in deformity spine surgery. Anterior access to thoracic spine is a challenging procedure. Thoracoscopic surgery reduce iatrogenic injuries in thoracic spine surgery.     

Thoracic spine injuries in victims of motorcycle accidents

Spinal cord injury can be devastating. Cervical spine roentgenography has been recommended in all severe multisystem trauma patients but little attention has been given to the thoracic spine. In a series of 266 motorcycle accident victims, seen over a 42-month period, 13 cases of thoracic spine injury were identified. During this same time interval four cases of cervical spine injury were identified. Eleven of the 13 cases involved a catapulting ejection from the motorcycle and resultant axial loading to the thoracic spine. Thoracic spine injuries are more common in these patients and therefore the thoracic spine should be immobilized until full thoracic spine roentgenography can be carried out.