钉-钩单椎体内固定+峡部植骨治疗青年腰椎峡部裂

目的评价单椎体内固定＋峡部植骨融合治疗腰椎峡部裂的临床疗效。方法对24例慢性腰痛（或）神经根症状的腰椎峡部裂（无脊柱滑脱）患者,采用单椎体内固定、峡部修整、峡部植骨融合治疗。结果24例均随访2年。患者下腰痛症状完全消失,未出现内固定系统的松动、断裂。X线及CT片均提示峡部已骨性融合。结论单椎体内固定＋峡部间植骨融合是一种治疗腰椎峡部裂简便、有效的方法。     

胸腰椎椎体骨样骨瘤的临床表现和切除重建策略

目的探讨胸腰椎椎体骨样骨瘤患者的临床表现特点和后路经椎弓根肿瘤切除植骨内固定手术的疗效。方法 2001年1月-2010年6月,收治8例胸腰椎椎体骨样骨瘤患者。男5例,女3例;年龄6～27岁,中位年龄15.5岁。出现症状至就诊时间为2～19个月,平均11.8个月。病灶节段:L2、L5各2例,L3、L4、T8和T10各1例。主要临床表现为腰背部疼痛,1例存在下肢放射痛,4例合并脊柱侧凸。病灶直径0.9～2.0 cm,平均1.6 cm。患者均行后路经椎弓根椎体内病灶刮除、打压植骨、一期内固定手术。结果手术时间70～170 min,平均110 min。术中出血量300～1 400 mL,平均720 mL。术后病理检查均证实为骨样骨瘤。患者切口均Ⅰ期愈合,腰背疼痛和下肢放射痛均完全消退,无并发症发生。术后随访时间12～58个月,平均39个月。随访期间无肿瘤复发及脊柱畸形发生。结论 CT能显示椎体骨样骨瘤低密度瘤巢和周围的骨硬化带,是胸腰椎椎体骨样骨瘤重要影像学检查方法;采用后路经椎弓根椎体内病灶刮除、打压植骨、一期内固定手术可获得较好疗效。     

Spontaneous reduction of spondylolisthesis during growth: a case report

Isthmic spondylolisthesis is a common cause of low back pain in children. It is associated with a defect in the pars interarticularis of the vertebra. The treatment depends on the clinical course and degree of spondylolisthesis. Low-grade isthmic spondylolisthesis usually shows a benign course without significant progression and therefore, conservative treatment is advised. Although isthmic pars defect can heal, initial existing degree of slippage persists. A complete reversion of deformity was never described yet. We present the case of a 7?-year-old girl with symptomatic grade 2 isthmic spondylolisthesis according to the Meyerding classification. Without any specific therapy, there was a radiologically documented near total reversion of slippage and total relief of clinical symptoms during 8 years of follow-up. Computed tomography scan after this period showed persisting pars interarticularis defect without signs of healing. This case report indicates that during growth, spontaneous reversion of vertebral slip in isthmic spondylolisthesis can occur, even without healing of the pars defect.     

Vertebral osteoid osteoma--peroperative detection of its nidus using a surgical gamma probe

The case of a vertebral osteoid osteoma localized in the arch and pedicle of the fourth lumbar vertebra in a young girl is described. The condition was manifested by the development of scoliosis, which was also the initial diagnosis. Because of painful muscle contractions and persistent pain at night, osteoid osteoma was suspected and then confirmed by scintigraphy. In order to minimize resection of the posterior stabilizing structures and to ensure removal of the complete nidus, surgery was carried out with the use of a surgical gamma probe. The method is based on administration of a radionuclide (99m Techneciumlabeled methylenediphosphonate) 2 to 3 h before the operation and intraoperative detection of the intensity of radiation directly in the operative wound. The values of impulses recorded over the nidus were more than ten-times higher than the background values, i.e., the impulses over the surrounding, unaffected bone. The nidus was exactly localized and removed as a whole. Posterolateral fusion without instrumentation was carried out. The patient was almost immediately free from night pain. After fixation with TLSO for 3 months, the patient started physical therapy. One year later she was without any complaints, fusion was healed and she had no relapse. The aim of this study was to draw attention to this less known and therefore less frequently employed method that may enable the surgeon to detect conditions otherwise difficult to localize. This method can also be used for other body sites if the lesion treated accumulates radionuclides.     

Osteoid osteoma of the dens axis

An osteoid osteoma of the dens axis was diagnosed by computed tomography and bone scintigraphy in a 14-year-old girl with a 1.5-year history of pain. No case of an osteoid osteoma of the dens axis has been published in the literature yet. Regarding its clinical and radiological appearance, this osteoid osteoma was essentially similar to osteoid osteomas in other locations, i.e., it had an osteolytic nidus surrounded by sclerosis, associated with nocturnal pain and a positive aspirin test.

     

Diagnostic modalities for the evaluation of pediatric back pain: a prospective study

The commonly taught premise that pediatric back pain frequently has an underlying diagnosis has been recently challenged. Previous studies have suggested that up to 84% of children with low back pain have associated serious diagnoses. Children with back pain, therefore, have frequently undergone exhaustive diagnostic testing. There have been few prospective studies, however, about the diagnosis rate and appropriate diagnostic methods for back pain in children. This study prospectively examines the rate of diagnosis for pediatric back pain and the value of various diagnostic studies for this problem. METHODS: All patients presenting to our institution with a chief complaint of back pain were evaluated for the study. Inclusion criteria consisted of age younger than 18 years, no previous back surgery, no previous diagnosis given, and duration of pain longer than 3 months. Seventy-three patients were enrolled in the study, and an algorithm was created for diagnostic evaluation. The algorithm incorporated commonly used diagnostic techniques including radiographs, magnetic resonance imaging, computed tomography, bone scan, and laboratory studies. The end point was considered to be either (1) a definitive diagnosis or (2) no diagnosis and no symptomatic or clinical changes during a 2-year period. RESULTS: Fifty-seven patients (78.1%) ended with no diagnosis. Of the remaining 16, 9 were diagnosed with spondylolysis with or without spondylolisthesis. Three other patients had abnormal laboratory values but no definitive diagnosis. Other diagnoses included Scheuermann disease (n = 2), osteoid osteoma (n = 1), and a herniated disk (n = 1). CONCLUSIONS: This investigation is the largest prospective study of diagnostic modalities in pediatric back pain to date. Contrary to most of the previously published data, most of our patients ended the study with no definitive diagnosis. In addition, the most of the diagnoses were made at initial physical examination or via initial plain radiographs. No diagnoses were missed using our algorithm. These results suggest that pediatric back pain frequently does not carry a definitive diagnosis and that exhaustive diagnostic protocols may not be necessary for this problem. LEVEL OF EVIDENCE: Prospective study; Level 2 clinical evidence.     

Progression of an osteoid osteoma to an osteoblastoma. Case report

The authors report the unusual case of a 25-year-old man with occipitocervical pain related to a lesion of the C-1 lateral mass. Initially this lesion measured 8 mm and exhibited radiological features of an osteoid osteoma. Seven years later, as pain increased and became unresponsive to antiinflammatory drugs, computerized tomography scanning demonstrated progression to a 16-mm lesion, highly suspicious of an osteoblastoma. After mobilization of the vertebral artery from the C-1 groove, the lesion was completely resected via an anterolateral approach. Complete symptomatic relief, restoration of cervical range of motion and preservation of cervical stability were achieved immediately after surgery, and the results were confirmed at the 4-year follow-up examination. Pathological examination of tissue samples confirmed the diagnosis of osteoblastoma. Osteoid osteoma rarely evolves to osteoblastoma. Deterioration of a patient's ability to control pain is a warning sign. Insight into such cases underlines the importance of close long-term radiological follow-up examination in patients with conservatively treated osteoid osteomas.     

Atypical presentation of an osteoid osteoma in a child

Osteoid osteomas are benign bone tumors that most commonly involve the long bones of the lower extremities, but do occur in the spine with some frequency. Patients with lesions in the spine typically present with back pain, scoliosis, and, less commonly, varying degrees of radicular leg pain. We report the case of a child with complaints of nonradicular leg pain. A combination of plain radiographs, scintigraphy, and axial imaging showed a lesion in the sacral spine consistent with an osteoid osteoma. After failed medical management, our patient was treated with intralesional excision, with complete resolution of symptoms.     

Early diagnosis of isthmic spondylolysis with MRI

INTRODUCTION: Early diagnosis of isthmic lumbar spondylolysis cannot always be established on plain radiographs and CT scans, only. In the case presented here, magnetic resonance imaging (MRI) showed typical bone marrow changes in T1- and T2-weighted images, even at an early stage. CASE: A 11-year old female judoka complained of deep lumbar pain with local tenderness to pressure at L3 to S1. Clinically, there was no neurologic deficit. Conventional x-ray showed no abnormalities. In contrast, MRI revealed a locally ill-defined bone marrow oedema in both pars interarticularis of the 5th lumbar vertebra. This was interpreted as the typical MR-tomographic feature of occult stress fracture, which has to be seen as early evidence of isthmic spondylolysis. Complete restitution was achieved after conservative treatment. CONCLUSION: In early spondylolysis--presented here in form of a case report--, changes of MR signal intensity in the pars interarticularis may be detected, even before fracture lines are to be seen on plain radiographs. Further studies are necessary to confirm MRI to be the method of choice for early diagnosis.     

Cervical osteoid osteoma. Report of a case and review of the literature]

One case of a cervical osteoid osteoma is presented and compared with infrequent similar cases from the literature. The authors recall the diagnosis difficulties, facing a long standing not explained neck pain due to poor neurological and current radiological informations. The interest of the bone scintigraphy, CT scan and M.R.I. are emphasized. Like in other cases, the pain disappeared after surgical removal of the tumor. The eventually associated scoliosis often rectify too.     

Bone scintigraphy in symptomatic spondylolysis

In 66 patients with back pain and suspected spondylolysis, the results of bone scintigraphy have been correlated with operative findings and clinical follow-up. Although bone scintigraphy is of little value for primary diagnosis, it helps to distinguish between those patients with established non-union of the defect, and those in whom healing is still progressing and who may benefit from immobilisation. We also found that increased uptake on the contralateral side to a unilateral spondylolysis is suggestive of impending fracture.     

Use of radionuclide method in preoperative and intraoperative diagnosis of osteoid osteoma of the spine. Case report

A 24-year-old man with persistent low back pain and right sciatica, was found to have an osteoid osteoma of the right pedicle of the second lumbar vertebra. 99mTc-MDP bone scan and CAT scan produced an early diagnosis of the lesion. Intraoperative 99mTc-MDP in vitro combined with imaging and quantitative activity measurements were useful for accurate localization and complete removal. The method is simple and can be performed in every nuclear medicine department, with no need for special operating room facilities.     

Late diagnosis of intraarticular osteoid osteoma treated as hip osteoarthritis--case report and review of the literature

A 34-year old men with left hip pain caused by intraarticular osteoid osteoma localized in the left femoral head is described. He was treated as a hip osteoarthritis for one year before the accurate diagnosis was established. Magnetic resonance imaging showed lesion indicating osteoid osteoma. Accurate diagnosis was established based on typical appearance of the osteoid osteoma on the computed tomography (CT). Osteoid osteoma rarely occures after 30 years of age and intraarticular locallisation is uncommon. This case report pinpoints the importance of careful analysis of monoarticular pain in order to avoid the possibile misdiagnosis of osteoid osteoma especially in young adult with an isolated osteoarthritis feature on the conventional radiography and normal laboratory findings. CT is specific and sensitive imaging modality for diagnosis of osteoid osteoma.     

Posttraumatisches Osteoidosteom Fallbericht und Literaturübersicht

Osteoid osteoma is a painful benign bone neoplasm that is rarely described after trauma but should be suspected. A case of osteoid osteoma 19 years after a tibial fracture is presented. The patient had pain in the tibia for 6 years before the osteoid osteoma was confirmed. He had been operated on twice for suspected osteomyelitis although the clinical symptoms suggested an osteoid osteoma. The radiographic appearance as well as a bone scan confirmed the diagnosis. Removal of the nidus resulted in immediate pain relief. A precise preoperative diagnosis of the lesion based on clinical findings, standard radiographs, high-resolution CT, and bone scan is mandatory. It is important to recognize this uncommon entity to avoid morbidity associated with a prolonged delay in diagnosis.     

48例儿童骨样骨瘤的诊断与治疗分析

[目的]探讨小儿骨样骨瘤的临床特点及治疗方法.[方法]对48例小儿骨样骨瘤的临床特点、X线特点及治疗方法进行回顾性分析.[结果]本组病例均经手术治疗,术后无复发,病变部位疼痛、跛行、脊柱侧凸症状均消失.无植骨反应,无病理性骨折.[结论]根据小儿骨样骨瘤的临床特点、患病部位疼痛及X线可见典型的瘤巢,诊断并不困难.因本病痛苦大,确诊后应早期手术治疗.     

Arthroscopic removal of an intra-articular osteoid osteoma of the radial styloid

We describe a case of intra-articular osteoid osteoma arising in the radial styloid of a 21-year-old man. Plain radiographs were not diagnostic, but computed tomography, gadolinium-enhanced magnetic resonance imaging, and bone scintigraphy suggested the possibility of an osteoid osteoma. We arthroscopically removed the lesion; histological examination confirmed the diagnosis. The patient's symptoms disappeared immediately after surgery.     

Osteoid osteoma of the hand and wrist

Eighteen cases of osteoid osteoma of the hand and wrist were treated between 1985 and 1999. The diagnosis was confirmed pre-operatively with X-rays, bone scintigraphy, CT, and MRI, and all the diagnoses were later confirmed by histological examination. The authors highlight the difficulties in the diagnosis of the osteoid osteoma of the hand and wrist. An accurate clinical history and a high index of suspicion are required. Three phase bones scans are highly sensitive for osteoid osteoma and should be used in conjunction with CT examination to facilitate diagnosis and pre-operative planning. All the patients were treated surgically, by removal of the tumour, with complete resolution of all symptoms.     

Multi-level spondylolysis

The incidence of isthmic spondylolysis is approximately 3% to 6% in the general population. Spondylolytic defects involving multiple vertebral levels, on the other hand, are extremely rare. Only a handful of reports have examined the outcomes of surgical treatment of multi-level spondylolysis. Here, we present one case of bilateral pars defects at L3, L4, and L5. The patient, a 46-year-old female, presented with lower back pain radiating into the left lower extremity. Radiographs and CT scans of the lumbar spine revealed bilateral pars defects at L3-L5. The patient underwent lumbar discectomy and interbody fusion of L4-S1 as well as direct repair of the pars defect at L3. There were no postoperative complications, and by seven months the patient had improved clinically. While previous reports describe the use of either direct repair or fusion in the treatment of spondylolysis, we are unaware of reports describing the use of both techniques at adjacent levels.     

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.