Osteoma arising from the lumbar articular process

A 57-year-old man presented with an extremely rare osteoma originating from the left L-5 inferior articular process and causing lumbo-crural sciatica. Postmyelography computed tomography and magnetic resonance imaging showed an osteoma compressing the spinal nerve root at the lateral recess. Decompression facetectomy and excision of the lesion followed by transforaminal lumbar interbody fusion between L-5 and S-1 provided complete relief from the symptoms. Histological examination confirmed the diagnosis of benign osteoma. The previous seven cases of spinal osteoma involved the vertebral body, pedicle and posterior elements. Spinal osteomas should be considered in the differential diagnosis of benign lesion originating from the articular process.     

Sacral kyphoplasty for relieving pain caused by sacral hemangioma

STUDY DESIGN: Case report describing sacral kyphoplasty in a patient with sacral hemangioma; the first account of this procedure in a sacral hemangioma. OBJECTIVES: To highlight the advantages of sacral kyphoplasty in the treatment of sacral tumors. SETTING: This study is made in Baskent University in Turkey. SUMMARY OF BACKGROUND DATA: Kyphoplasty and sacroplasty are new, minimally invasive techniques that are mostly used for treating osteoporotic vertebral body fractures. These techniques are very effective for achieving rapid pain relief and stabilizing the vertebra, and biopsy collection can be included in the procedure. The latter allows for informed treatment planning in patients with metastatic tumors. METHOD: A 74-year-old woman with known metastatic renal cell carcinoma was investigated for pain in the left sacral region. A tumoral lesion was detected, and sacroplasty was performed at S1. RESULTS: The sacral pain resolved completely after the procedure, and the patient was able to walk without assistance. The pathological diagnosis for the vertebral lesion was hemangioma. CONCLUSIONS: Sacral kyphoplasty is a very effective, minimally invasive surgical procedure. Patients with debilitating diseases such as primary sacral tumors or metastases can be treated by this technique with no significant complications.     

Modifizierte perkutane Ballonkyphoplastie bei Osteolyse des BWK11 und Kommunikation mit dem Spinalkanal

This paper presents the case report of a 67-year-old man who came to our hospital suffering from severe osteolysis of the 11th thoracic vertebral body. The patient has been suffering from renal cell carcinoma for 2 years. During a routine control the above-mentioned lesion was found by chance. A few days later pain started in the thoracolumbar region. Treatment was intended to be palliative. Therefore, we looked for an option to stabilize the vertebral body as minimally invasive as possible. Because of a destroyed trailing edge of the vertebra, "normal" kyphoplasty was not possible. For this reason, we performed a modification, using one filled balloon as a kind of curtain between the vertebral body and spinal canal. With this technique we achieved an optimal filling of the destroyed vertebral body with cement, without any leakage. Two days postoperatively, the patient could leave our hospital without any pain symptoms.     

Cystothecostomy: a new technique to treat long segment spinal extradural arachnoid cyst

Pathogenesis and treatment of the spinal arachnoid cyst has not been well established. A novel method of treatment of a long segment spinal arachnoid cyst is being presented in a 9-year-old boy. He presented to us with a slowly progressive spastic paraparesis. MRI revealed dorsal epidural arachnoid cyst extending from T7 vertebral body to L1 body producing marked cord compression. In order to save the child from a long segment laminectomy or laminoplasty, a new minimally invasive technique was devised. In this technique L1 laminectomy was performed under local anaesthesia, and the cyst was communicated to thecal sac by making an interconnecting stoma. We named this procedure as cystothecostomy. There was gradual neurological recovery after the procedure.     

Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report

Vertebral hemangiomas are common entities that rarely present with neurological deficits. The authors report the unusual case of a large L-3 vertebral hemangioma with epidural extension in a 27-year-old woman who presented with hip flexor and quadriceps weakness, foot drop, and leg pain. The characteristics of the mass on magnetic resonance imaging suggested an aggressive, hypervascular lesion. The patient underwent embolization of the lesion followed by direct intralesional injection of ethanol. Significant resolution of clinical symptoms was observed immediately after the procedure and at her follow-up visits. Follow-up imaging studies obtained 9 months after the procedure also documented a considerable reduction in the size of the hemangioma with minimal loss of vertebral height and a mild kyphosis at the affected level. On repeated imaging studies obtained 21 months postoperatively, the size of the hemangioma and the degree of vertebral body compression were stable. As demonstrated in this case, patients with vertebral hemangiomas can present with acute nerve root compression and signs and symptoms similar to those of disc herniation. Vertebral hemangiomas can be treated effectively with interventional techniques such as embolization and ethanol injection.     

Minimally invasive anterior approach for kyphoplasty of the first thoracic vertebra in a patient with multiple myeloma.

A vertebral body collapse of the first thoracic vertebra (T1) was diagnosed after radiological investigation in an adult male suffering for severe dorsal pain due to suspected multiple myeloma (MM). According to the principles of minimally invasive neurosurgery and the aesthetic needs of the patient, an open T1 kyphoplasty was performed by means of a right anterior approach through the inferior brow of the neck, generally utilized for the anterior approaches to the cervical spine. The histological examination confirmed the diagnosis of MM and the postoperative radiological investigation showed a good vertebral body (VB) restoration. No gross neurological deficit was noted and the patient was discharged within a few days after a good recovery. Kyphoplasty is a percutaneous technique utilized by means of a posterior approach for VB restoration from T4 to the fifth lumbar vertebra (L5) in patients with vertebral body compression fractures (VCFs) of osteoporotic, traumatic and neoplastic origin. Anatomic obstacles make the performance of posterior kyphoplasty from T1 to T4 very difficult. To the best of our knowledge no anterior approach for T1 kyphoplasty has been reported in the literature. Our experience gives us the opportunity to emphasize this approach and this technique for the minimally invasive treatment of the VCFs of this segment of the spine.     

Successful treatment of a bifocal eosinophilic granuloma of the spine with CT-guided corticosteroid injection

Observation and immobilization is adequate for most patients with spinal eosinophilic granuloma; however, in patients with symptomatic lesions, treatment other than simple observation or biopsy alone is recommended. In view of the benign clinical course of eosinophilic granuloma, a simple, minimally invasive, outpatient treatment with a low complication rate such as computed tomography (CT)-guided intralesional corticosteroid injection may be considered the treatment of choice. This article presents a case of a 21-year-old man with a symptomatic bifocal eosinophilic granuloma at the vertebral body of the L3 vertebra and the left T5 costovertebral joint treated effectively by CT-guided intralesional methylprednisolone injection. To the best of our knowledge, this is the first case of successful treatment of a bifocal eosinophilic granuloma with CT-guided corticosteroid injection. Under general anesthesia and CT guidance, the lesion was located through the right transpedicular approach for the L3 lesion and the left posterolateral approach for the T5 lesion using a biopsy trocar. Tissue sample was retrieved and frozen section biopsy showed eosinophilic granuloma. One intralesional CT-guided injection of 80 mg (2 mL) of methylprednisolone acetate was performed in each lesion. Complications related to the procedure were not observed. The patient was admitted postprocedural for overnight medical evaluation and was discharged from the hospital the next day. Complete resolution of pain was observed 72 hours after the procedure. At 5 years after diagnosis and treatment, the patient is asymptomatic; imaging showed healing of both lesions.     

Paget's disease of bone affecting a single vertebra: Clinical,radiologic, and histopathologic correlations

Summary We report a 67-year-old man who presented with a 3-month history of progressively increasing pain in the lumbar spine. His past medical history was unremarkable, and physical examination disclosed local tenderness over the lower spine. No neurologic dysfunction was identified. Routine laboratory evaluation including alkaline phosphatase activity was normal. An X-ray film of the lumbar spine showed enlargement and increased density of L-5 vertebra. A wholebody bone scan revealed markedly increased uptake at the L-5 level. To further evaluate the nature of the disorder and the cause of his pain, a computed tomography (CT) scan was obtained. It disclosed multiple lucent areas with some sclerotic changes mainly affecting the vertebral body of L-5. No spinal stenosis was found. Subsequently, a bone biopsy of L-5 was performed that showed typical findings consistent with Paget's disease. The patient was treated with etidronate (200 mg b.i.d. for 6 months) followed by salmon calcitonin (50 IU 3 times/week s.c. for 6 months). The pain declined gradually in severity and the patient became symptom free after 12 months of treatment. A repeat X-ray film, obtained at that time, showed no significant change. However, a bone scan showed almost complete normalization. The present case illustrates that a high index of suspicion is required when only a single vertebra is affected by Paget's disease, especially, when alkaline phosphatase activity is normal. It may present with severe pain without evidence of neurologic dysfunction. CT scan may be a useful adjunct in establishing the diagnosis and elucidating the cause of pain.     

Epidural spinal cavernous hemangioma

A 28-year-old woman presented with a rare primary epidural hemangioma without adjacent vertebral involvement manifesting as progressive paraparesis. Magnetic resonance imaging of the thoracic spine showed an epidural lesion at T4-5 space appearing as isointense on T1-weighted images with enhancement by contrast medium and hyperintense on T2-weighted images. The lesion was totally removed microsurgically. Histological examination revealed cavernous hemangioma. She made a complete recovery from her symptoms and has remained asymptomatic for 9 years.     

Computer-Assisted Navigation Full Visualization Spinal Endoscopic Surgery for Lumbar Vertebral Osteoid Osteoma

Background

Osteoid osteoma is a benign osteogenic tumor that occurs mostly in the femoral stem, while osteoid osteoma occurring in the lumbar vertebral body is a relatively rare case. To minimize treatment-related complications, a computer-assisted navigation fully visualized spinal endoscopy was used. Ultimately, the pathology was diagnosed as osteoid osteoma.

Case Presentation

We report a 19-year-old adult male with low back pain that worsened at night and CT, MRI imaging showed an abnormal signal shadow at the posterior margin of the lumbar vertebral body. Due to the proximity of the lesion to the spinal canal and adjacent to the nerve roots, it was difficult to precisely localize the lesion by purely endoscopic or open procedures, and if necessary, the resection of surrounding tissues had to be expanded, causing unnecessary damage to the surrounding tissues. Therefore, we choose computer-assisted navigation fully visualized spinal endoscopy to perform the treatment.

Conclusion

In this case, we report an osteoid osteoma that occurs less frequently in the lumbar vertebral body. Using computer-assisted navigation with fully visualized spinal endoscopy, we successfully resected the osteoid osteoma at the posterior margin of the L3 vertebral body preoperatively by computer-planned path with intraoperative visualization endoscopy, minimizing the damage to spinal stability. Computer-assisted navigation with visualization endoscopy provides a more precise and minimally invasive approach to the treatment of osteoid osteoma of the spine.     

Spinal cord compression by a unifocal eosinophilic granuloma: a case report of an adult with unusual roentgenological features

We describe an unusual case of unifocal eosinophilic granuloma of the spine in a 38-year-old woman who presented with spinal cord compression. After 2 years of back pain, x-ray films of the spine were normal, but computed tomography and magnetic resonance imaging demonstrated a lytic lesion of the 1st lumbar vertebral body with cephalic extension in the epidural space. The lesion was later confirmed at operation to be an eosinophilic granuloma spreading into the surrounding tissues.     

Vertebral hemangioma extending into the spinal canal: case report

A 73-year-old woman was admitted to our hospital presenting slowly progressive hypoesthesia below the 5th thoracic dermatome and spastic paraparesis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in the T3 vertebral body extending into the spinal canal. The spinal cord was compressed to the left side and right T3 and T4 nerve roots were encased in the mass lesion. One week after admission, T2-T4 laminectomy was performed to relieve the spinal cord compression. A highly vascularized tumor was observed in the epidural space at T3 and T4 levels. The tumor in the spinal canal was removed. The histopathological diagnosis was cavernous hemangioma. The patient's symptoms improved after the surgery. Asymptomatic vertebral hemangiomas are common, but its extraosseus extension causing neurologic symptoms (compressive vertebral hemangioma) is rare. The clinical symptoms, the radiological features, and the strategies for the treatment of compressive vertebral hemangiomas were discussed.     

Management of an extensive spinal epidural abscess from C-1 to the sacrum. Case report

The authors report a rare case of extensive spinal epidural abscess in an immunocompromised young woman. The patient presented with low-grade fever, back pain, and progressive lower limb weakness. The MR imaging of her whole spine revealed an epidural abscess extending from C-1 to the sacrum. She was treated using a minimally invasive surgical technique and showed excellent recovery. The authors review the current literature along with different modes of surgical treatment available for this unusual clinical entity.     

Peripheral primitive neuroectodermal tumor causing cauda equina syndrome with destruction of L5 vertebra

A 24-year-old male patient presented with cauda equina lesion symptoms. His clinicoradiological examination including X-rays, CT scan and MRI revealed destruction of L₅ vertebral body, pedicle and a mass extending to lateral recess and left intervertebral foramina causing pressure over the thecal sac. A CT guided FNAC was inconclusive. Open biopsy and hemilaminectomy of L₅ vertebra was performed. Histopathology and immunocytochemical analysis revealed it to be primitive neuroectodermal tumor. Patient was given chemotherapy and radiation therapy. His lower limb power improved by grade I post operatively and at 2 years follow-up bowel/bladder recovery was noticed. Patient died after 2.5 years of surgery because of pulmonary metastasis.     

粗套管穿刺针在胸腰椎椎体病变穿刺活检中的应用

目的:探讨粗套管穿刺活检针在胸腰椎椎体病变穿刺活检中的应用价值.方法:对2004年2月～2009年8月在我院行手术治疗并于术前行病变穿刺活检病理检查的54例胸腰椎椎体病变患者进行回顾性分析,患者年龄15～78岁,平均50.6岁;男30例,女24例.均有局部疼痛,12例伴下肢不同程度的放射痛;43例局部压痛,下肢不同程度的感觉异常.术前均行脊柱X线片和CT检查,均为单椎体病变,表现为不同程度的椎体骨质破坏,其中胸椎30例(T4 7例,T5 2例,T6 7例,T7 8例,T8 5例,T11 1例),腰椎24例(L1 1例,L28例,L3 4例,L4 5例,L5 6例),均在手术治疗前行CT引导下粗套管穿刺活检针病变穿刺活检.比较穿刺活检病理诊断与术后病理诊断的符合情况.结果:无穿刺活检并发症发生.穿刺活检病理诊断恶性肿瘤28例,良性肿瘤1例,可疑恶性肿瘤1例,正常组织1例,炎性病变23例,共52例有明确的病理诊断,穿刺活检病理诊断阳性率为96.3％;穿刺活检病理诊断与术后病理诊断一致51例,诊断符合率为98.1％.1例穿刺活检病理诊断为可疑恶性肿瘤,术后病理诊断为腺癌;1例穿刺活检病理诊断为正常组织,术后病理诊断为非特异性炎症;1例穿刺活检病理诊断为化脓性感染,术后病理诊断为结核.结论:粗套管穿刺活检针在胸腰椎椎体病变穿刺活检中能够取得较为充足的标本量,穿刺活检病理诊断阳性率及穿刺活检病理诊断与术后病理诊断符合率均较高.     

Spondylitis without epidural abscess formation following short-term use of an epidural catheter

A 42-year-old patient had undergone total hip replacement for aseptic femoral head necrosis 9 years previously. He now presented with loosening of the prosthesis and pseudoarthrosis sustained following a femoral shaft fracture 7 months earlier. A total hip replacement was carried out in general anaesthesia combined with an epidural catheter. The epidural catheter was removed on the third postoperative day, after which the patient complained of persistent lumbar pain which was associated with meningismus, fever, leucocytosis and a raised erythrocyte sedimentation rate. In spite of intensive laboratory and radiological investigation, 15 weeks elapsed before a radiological diagnosis of spondylitis of L1 and L2 could be made. Aspiration biopsy of the L1/L2 disc space yielded a growth of Pseudomonas aeruginosa. Antibiotic therapy was begun immediately but could not prevent spread of infection to the adjacent disc-space T12/L1 and the vertebral body T12. The patient made a slow recovery and was discharged in a satisfactory condition wearing a lumbar brace some 9 months after the operation. No evidence of epidural abscess formation was found at any stage and no direct connection between the use of the epidural catheter and spondylitis could be established.     

Tumoral calcinosis in bilateral facet joints of the lumbar spine in scleroderma. Case report

Tumoral calcinosis commonly occurs in the articular soft tissues of the extremities but rarely in the spine. The authors performed surgery to treat lumbar tumoral calcinosis in a patient with scleroderma, in whom symptoms of neurological dysfunction had manifested. This 49-year-old woman presented with low-back pain and gait disturbance. Seven years before presentation, scleroderma had been diagnosed, and the patient had received medical treatment ever since. Imaging revealed tumoral calcinosis centered at the bilateral facet joints between L-3 and L-4, marked stenosis of the spinal canal, L-3 spondylolisthesis, and intervertebral instability. Surgery was performed to excise the lesion en bloc. After neural decompression, posterolateral fusion and pedicle screw fixation were undertaken. Symptoms improved after surgery. In this case, the underlying scleroderma that predisposes to calcinosis and facet joint degeneration due to lumbar spondylolisthesis were probably factors leading to the development of tumoral calcinosis in the lumbar spine.     

Kyphoplastie und Vertebroplastie bei Frakturen im hohen Lebensalter

Kyphoplasty and vertebroplasty are two minimally invasive percutaneous techniques used for treatment of osteoporotic vertebral compression fractures in the thoracic and lumbar spine. The injection of polymethylmetacrylate (PMMA) is often a final attempt at therapeutic treatment of complications due to such fractures. Vertebroplasty involves injection of cement via one or both pedicles under high pressure, thus filling and stabilizing the vertebra without reduction of fracture. Extravertebral cement leakage is a common complication: an intact posterior wall normally prevents cement leakage into the epidural space. Kyphoplasty involves transpedicular inflation of balloon tamps, thus creating a cavity which is then filled with PMMA under low pressure. Restoration of vertebral height is possible and the potential for extravertebral cement leakage lessened.     

Acute lumbosacral hemorrhagic ganglion cyst after transforaminal epidural steroid injection

Epidural steroid injection is one of the most commonly used non-surgical treatments for degenerative lumbar vertebral disease. Its use has increased as degenerative lumbar vertebral disease has increased in frequency. Concomitant complications are being reported more often. In this report, we report a rare case of iatrogenic hemorrhagic cyst following epidural steroid injection. The patient underwent operative treatment with complete resolution of his symptoms     

CT介导同轴套管针脊柱病变经皮活检术

目的探讨CT介导同轴套管针经皮活检术在脊柱病变临床诊治中的价值。方法CT引导下同轴穿刺套管针经皮穿刺活检脊柱病变37例,其中胸椎9例,腰椎13例,骶椎8例,胸腰椎同时累及7例。根据病变的部位,采用经椎弓根或椎旁入路,进入病变部位后旋转套管切割病变组织,送组织学检查。结果所有37例患者均穿刺成功,每例患者获穿刺组织块1～4块,平均2.1块;34例获明确诊断,分别为转移性肿瘤15例,结核9例,脊索瘤5例,多发性骨髓瘤2例,骨巨细胞瘤2例,嗜酸性细胞肉芽肿1例,成功率91.9%;无一例严重并发症。结论CT介导同轴套管针脊柱病变经皮活检术诊断率高,并发症少,且微创、安全,价格低廉,值得在临床推广应用。