Pigmented villonodular synovitis of a lumbar intervertebral facet joint |
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| Authors: | Ahmet Murat Müslüman Halit Çavuşoğlu Adem Yılmaz Türker Dalkılıç Canan Tanık Yunus Aydın |
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| Affiliation: | 1. Neurosurgery Clinic, ?i?li Etfal Education and Research Hospital, ?stanbul, Turkey;2. Pathology Department, ?i?li Etfal Education and Research Hospital, ?stanbul, Turkey;1. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 St. Clair, Suite 2210, Chicago, IL 60611, USA;2. Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, 127 Changle West Road, Xi''an, Shaanxi 710032, China;3. Department of Orthopaedics, Beijing Tiantan Hospital, The Capital Medical University, Beijing 100050, People''s Republic of China;4. Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, People''s Republic of China;5. The Spine Clinic of Los Angeles, Good Samaritan Hospital, University of Southern California, 1245 Wilshire Blvd, Suite 717, Los Angeles, CA 90117, USA;1. Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan;2. Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan;3. Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan;4. Advanced and Specialized Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan;1. Department of Neurosurgery, Tufts Medical Center and Tuft University School of Medicine, 800 Washington Street, Boston, MA 02111, USA;2. Department of Anatomic Pathology, Lahey Clinic, Burlington, MA, USA;3. Department of Neurosurgery, Lahey Clinic, Burlington, MA, USA;1. Graduate School of Medicine, University of Ulsan, Seoul, Republic of Korea;2. Department of Neurological Surgery, Hallym University College of Medicine, Hwaseong, Republic of Korea;3. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea |
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| Abstract: | Background contextPigmented villonodular synovitis (PVNS) is a slowly progressive lesion of uncertain etiology that involves the synovial membrane of joints or tendon sheaths. Only rarely does PVNS affect the axial skeleton, where it arises from the vertebral articular facet joint. Its treatment and prognosis remains limited.PurposeTo describe our management in a patient with PVNS and to review previously published cases.Study designCase report.MethodsThis is a case report of a 59-year-old woman who presented left sciatica. Computed tomography (CT) imaging revealed a mixed sclerotic and lucent lesion affecting the left L4–L5 facet joint. Magnetic resonance imaging (MRI) demonstrated a diffusely infiltrative process that originated from the left inferior articular process of L4 vertebra with extension into the spinal canal. A total synovectomy with left L4 hemilaminectomy was performed. Left L5 root was decompressed with total microscopic tumor removal. Decompression of spinal canal and absence of the tumor was shown by MRI and CT scan after the operation.ResultsComplete resolution of the patient's complaints was achieved. Histopathological analysis was consistent with a diagnosis of PVNS.ConclusionsThe principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. It is also important to totally remove the synovium, the origin of PVNS, to prevent the recurrence. |
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