PubMed · 15338337
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J Flitsch, E Fritzsche, L Papavero. 2004-08-30. Spondylodiscitis caused by occult endocarditis.. https://doi.org/10.1007/s00701-004-0356-7
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Pigmented villonodular synovitis (PVNS) is a rare proliferative lesion that can affect synovial membranes, tendon sheaths, and bursae. It is usually a monarticular disease of the lower extremities, and so far fewer than 30 cases of spinal involvement have been reported in the literature. We describe a patient with progressive lumbar pain and spinal claudication, in whom a CT scan of the lumbar spine revealed destruction fo facet joints L3 to L5. An open biopsy was performed, which led to the diagnosis fo PVNS. The patient underwent successful surgical resection of the tumour mass and stabilization of segments L3 to S1. Two years after surgery the patient has no signs of recurrence. Differential diagnosis of erosive vertebral joint disease is discussed.
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Infectious spondylodiscitis is increasingly prevalent in the elderly population. Despite modern imagery techniques, time between onset of symptoms and diagnosis is still important and directly affects mortality rate. The systematic use of red flags for back pain patients should be able to improve this situation. In case of clinical and radiological suspicion of infectious spondylodiscitis, every effort should be directed toward the characterization of the bacteria before the introduction of antibiotics. Most of the time conservative treatment with antibiotics and bracing is appropriate but in selected cases a surgical procedure is advised, specifically in case of severe motor deficit or in the presence of non-tuberculosis abscess.