Implantation metastasis in a 13-year-old girl: a case report

We report a case of a 13-year-old girl with an osteosarcoma of the right humerus, which had been diagnosed as an aneurysmal bone cyst at our institution. She underwent curettage and bone grafting of the lesion, which resulted in implantation metastasis of the tumour to the ilium. She died 15 months after presentation owing to pulmonary metastases. This report highlights the possibility of metastasis occurring by direct implantation to a graft donor site. We strongly recommend that a biopsy be performed in cases of presumed benign lesions before proceeding with the definitive surgery.     

Scaphoid stress fracture in a 13-year-old gymnast: a case report

We present a 13-year-old gymnast with a stress fracture of the scaphoid. Treatment was successful with immobilization for 8 weeks in a long arm spica cast followed by 4 weeks in a short arm splint.     

Long-standing pain in a 25-year-old patient with a non-diagnosed cervical osteoblastoma: a case report

Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40–50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.     

Variant of a lumbar disc cyst in a 13-year-old girl: a case report

A disc cyst is a rare entity with a clinical presentation that closely mimics an intervertebral disc herniation. Disc cysts are ventrally located, intraspinal, extradural cystic lesions that communicate with the parent intervertebral disc through a ruptured annulus. We present the clinical features, magnetic resonance imaging, intra-operative and histopathological findings of a variant of a lumbar intervertebral disc cyst in a 13-year-old girl who presented with a 6-month history of unilateral radiculopathy following an injury. Magnetic resonance imaging revealed a large posterocentral, fluid-filled cyst occupying the L5-S1 interspace and bulging into the spinal canal. The cyst was confined within an intact bulging annulus fibrosis and extended directly from the parent disc. The cyst was surgically decompressed, resulting in complete symptomatic relief.     

Juvenile Osteochondritis Dissecans in a 13-year-old male athlete: A case report

Objective:

To present the clinical management of juvenile osteochondritis dissecans (OCD) of the knee and highlight the importance of a timely diagnosis to optimize the time needed for less invasive, non-operative therapy.

Clinical Features:

A 13-year-old provincial level male soccer player presenting with recurrent anterior knee pain despite ongoing manual therapy.

Intervention and Outcome:

A multidisciplinary, non-operative treatment approach was utilized to promote natural healing of the osteochondral lesion. The plan of management consisted of patient education, activity modification, manual therapy, passive modalities and rehabilitation, while being overseen by an orthopaedic surgeon.

Conclusions:

Considering the serious consequences of misdiagnosing osteochondritis dissecans, such as the potential for future joint instability and accelerated joint degeneration, a high degree of suspicion should be considered with young individuals presenting with nonspecific, recurrent knee pain. A narrative review of the literature is provided to allow practitioners to apply current best practices to appropriately manage juvenile OCD and become more cognizant of the common knee differential diagnoses in the young athletic population.     

Cervical spine osteoblastoma presenting as mechanical neck pain: a case report

Osteoblastoma is a benign bone-forming tumor that represents approximately 1% of all primary bone tumors. It occurs 40% of the time in the spine, most commonly in the posterior elements. The clinical presentation in this case is of chronic neck pain and stiffness. Although most lesions are well visualized on plain films, a bone scan or CT scan may be of better diagnostic value. Treatment is via surgical excision. In this report we present a case of cervical osteoblastoma mistaken for mechanical neck pain.     

Chiropractic management of abdominal aortic aneurysm: a case report

Aortic dilatation is a common and potentially life-threatening condition with which a patient may present to the chiropractor. It is most often detected in males over 50, particularly in association with hypertensive disease. This case illustrates the classic clinical and radiologic features of a large (13cms) abdominal aortic aneurysm. The manipulative management of patients with abdominal aortic aneurysm is discussed.     

A 14-year-old competitive, high-level athlete with unilateral low back pain: case report

Objective:

To detail the presentation of a male adolescent competitive high-level soccer player with left sided low back pain that occurred while playing soccer. This case will outline the importance of early detection, risk of progression and management of active spondylolysis in adolescent athletes.

Clinical Features:

The patient initially presented to a chiropractic sport specialist with left sided low back pain (9/10 on numeric pain scale rating) while kicking soccer balls with his left leg of one month duration. He was initially diagnosed with mechanical low back pain and successfully treated for acute pain management including removal from sport specific training and competition, soft tissue therapy and advice to rest. The chief complaint returned however, when the athlete resumed training and competition. A plain film imaging report suggested only postural alterations in an otherwise normal study of the lumbar spine. Computed tomography images taken three months later revealed a fracture at the left L5 pars interarticularis.

Summary:

The early detection of spondylolysis combined with an effective plan of management including rest and conservative therapy with a progressive return to play may allow competitive athletes to resume participation at an elite level.     

Chiropractic and exercise for seniors with low back pain or neck pain: the design of two randomized clinical trials

Background  

Low back pain (LBP) and neck pain (NP) are common conditions in old age, leading to impaired functional ability and decreased independence. Manual and exercise therapies are common and effective therapies for the general LBP and NP populations. However, these treatments have not been adequately researched in older LBP and NP sufferers.