Extraspinal pathology and incidental disc herniation in patients with sciatica.
Explore the source record for details and available documents.
Adult↗
SEARCH · PubMed Health
Results for “Spinal Neoplasms”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Primary spinal epidural lymphoma mimicking lumbar spinal stenosis. A case report.
Explore the source record for details and available documents.
Aged↗
Application and results of the AO internal fixation system in nontraumatic indications.
The AO internal skeletal fixation system (ISFS) permits posterior spine fixation to be restricted to the vertebrae immediately adjacent to the lesion and allows manipulation of each instrumented vertebra in three planes. In a prospective study to assess the value of this fixation for adult spinal disorders, 68 patients were reviewed. The device was used in spondylolisthesis, postlaminectomy instability, post-traumatic kyphosis, degenerative scoliosis, spinal stenosis, tumors, and infections. A total of 322 transpedicular screws have been inserted without neurologic complication. Satisfactory results were achieved in 88% of the patients, and only four pseudarthroses (6%) occurred. The ISFS provides rigid stabilization to enhance bone graft consolidation and to allow rapid postoperative mobilization in a light external orthosis.
Bone Screws↗
Multilevel osteochondroma of the lumbar spine presenting as spinal stenosis.
Explore the source record for details and available documents.
Adult↗
On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature.
STUDY DESIGN: A criteria-based review of the literature was conducted regarding the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain. OBJECTIVES: To perform meta-analysis of the literature regarding signs and symptoms in diagnosing radiculopathy, ankylosing spondylitis, and vertebral cancer. SUMMARY OF BACKGROUND DATA: Diagnosing low back pain, especially in general practice, depends largely on history taking, physical examination, and the erythrocyte sedimentation rate. No previous review has assessed the diagnostic accuracy of signs and symptoms in a systematic way, taking into account the methodological quality of studies. METHODS: The literature was reviewed for relevant studies. Retrieved studies were independently rated for methodological quality by two reviewers. The reported sensitivity and specificity in the rated studies were reviewed. RESULTS: Thirty-six eligible studies were retrieved. Major methodological shortcomings were observed, and only 19 studies scored > or = 55 points (maximal score 100). Not one single test appeared to have high sensitivity and high specificity in radiculopathy. The combined history and the erythrocyte sedimentation rate had relatively high diagnostic accuracy in vertebral cancer. Getting out of bed at night and reduced lateral mobility seemed to be the only moderately accurate items in ankylosing spondylitis. CONCLUSIONS: Additional studies that take into account the shortcomings identified would be needed to produce definite conclusions. Few of the studied signs and symptoms seemed to be valuable diagnostics for radiculopathy, ankylosing spondylitis, and vertebral cancer. Reproducibility of signs and symptoms over time might be a valuable diagnostic criterion. However, this was neglected in almost all studies.
Blood Sedimentation↗
Multifocal giant cell tumors in the spine. A case report.
STUDY DESIGN: This is a case report of a patient with two giant cell tumors, the first in thoracic spine and the second, two years later, in the sacrum. OBJECTIVES: To report the first patient in whom multifocal primary giant cell tumors have been found in the spine. SUMMARY OF BACKGROUND DATA: There have been no similar previous reports. METHODS: The diagnoses were made by biopsy. RESULTS: Curative removal of both tumors was achieved. CONCLUSIONS: More than one primary giant cell tumor in the spine can develop.
Adult↗
Giant intrasacral cellular schwannoma treated with high sacral amputation.
STUDY DESIGN: A case report of a man with a gigantic cellular schwannoma in the sacrum treated with high sacral amputation accompanied by careful nerve root-sparing dissection. OBJECTIVES: To describe the atypical clinical course of an intrasacral cellular schwannoma and the surgical procedure of high sacral amputation performed in a way to prevent needless sacrifice of functionally essential nerve roots. SUMMARY OF BACKGROUND DATA: Fundamentally, a cellular schwannoma is a benign tumor, but the clinical course is atypical. The symptoms are mild and the clinicopathologic features often mislead us to make a diagnosis of malignancy. The occurrence rate of intraosseous cellular schwannoma was reported to be 0.2% of all bony tumors, and the main location was the retroperitoneal space in the pelvis. Forty-one cases of giant intrasacral schwannomas have been reported so far. Among them, large sacral schwannoma with anterior cortex erosion and associated intrapelvic extension was extremely rare. METHODS: The patient presented with a 5-year history of right leg and buttock pain, which did not disturb his daily activities. After a histopathologic diagnosis and a complete set of image studies, high sacral amputation with preservation of uninvolved nerve roots was performed at S1-S2 through a combined anterior and posterior approach. Both S1 nerve roots and the right S2-S3 nerve roots were saved using a threaded saw. The lumbar spine was stabilized to the pelvic girdle using spinal instrumentation with posterolateral fusion. RESULTS: Eighteen months after the tumor was resected the patient had a very good clinical outcome, and there were no radiologic signs of instability or recurrence of the tumor. Locomotor function of both lower extremities and bowel and urinary functions were well maintained. The patient returned to his previous work. CONCLUSIONS: High sacral amputation following a combined anteroposterior approach provided good results without causing any disability. A detailed preoperative planning and careful dissection of uninvolved nerve roots prevented unnecessary neurologic impairment in locomotion and the detrusor and anorectal function.
Dissection↗
Painful osteolytic metastasis of the atlas: treatment with percutaneous vertebroplasty.
STUDY DESIGN: Technical note. OBJECTIVE: To describe a technique for performing percutaneous vertebroplasty of C1 for treatment of osteolytic metastatic disease involving the lateral portions of the atlas in which precautions are taken to protect the vertebrobasilar arterial supply and a posterior access route is used for cement delivery. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty (PVP) has proved to be efficient for the treatment of painful osteolytic vertebral disease. Good clinical experience with this technique suggested its extension to stabilize a painful osteolytic lesion of the atlas. METHODS: A patient with known parotid cancer presented with neck pain refractory to conservative treatment. On computed tomography, osteolytic destruction of the atlas that mainly involved the right lateral mass and surrounded the vertebral artery was found. On digital subtraction angiography, the lesion was shown to be highly vascularized and supplied mainly by direct branches of the ipsilateral vertebral artery. To avoid the risk of cement reflux from the tumor vascular bed to the involved vertebral artery, coil occlusion of the involved V3 segment was performed before vertebroplasty. Percutaneous vertebroplasty was then carried out using a percutaneous posteroanterior direction access route. RESULTS: Satisfactory filling of the osteolytic lesion with cement was achieved radiologically. Three days after the intervention and at a 9-month follow-up examination, the patient was free of pain. CONCLUSIONS: Vertebroplasty used to treat an osteolytic lesion of the atlas involving the lateral mass was performed by a posterior percutaneous approach. To prevent vertebrobasilar embolism, the involved vertebral artery was occluded before polymer injection.
Aged↗
Primary leptomeningeal melanoma.
STUDY DESIGN: A retrospective review of a case of primary leptomeningeal melanoma. OBJECTIVES: To present a previously undescribed tumor of the lumbar meninges. BACKGROUND: The case described the first report of lumbar localization and of bony metastasis of this tumor. METHODS: The authors present a case of a 65-year-old man with a destruction of the fifth lumbar vertebra and an exacerbation of lumbar pain and acute sensorimotor radiculopathy. RESULTS: The histologic examination of the resected tissue after the transpedicular stabilization suggested the presence of metastatic melanoma. After the development of progressive paraplegia and a second operation, subsequent histologic examination of the resected tissue showed the lesion to be a primary leptomeningeal melanoma. The patient's condition deteriorated progressively, and 31 days after confirmation of the diagnosis, he died of meningeal melanomatosis. CONCLUSION: By indicating the possibility of hitherto unreported sites of occurrence, routes of metastatic spread, and manifestations of this malignant tumor, this case report may contribute to the further elucidation of this disease.
Aged↗
Myopericytoma of the thoracic spine: a case report.
STUDY DESIGN: A case of myopericytoma of the thoracic spine is reported. OBJECTIVE: To report a recently described and extremely rare soft tissue neoplasm in the previously unreported location of the thoracic spine. SUMMARY OF BACKGROUND DATA: Myopericytoma is a recently described soft tissue neoplasm with perivascular myoid differentiation. All cases have been reported in the subcutaneous and superficial soft tissues of the extremities. This represents the first reported case of this unusual lesion in the spine. METHODS: A patient with a 3-month history of progressive weakness of the arms and legs was found to have a lytic lesion of T3. The lesion was surgically treated by curettage followed by a course of radiation. Presenting symptoms, imaging studies, histologic findings, and related literature are reviewed in this study. RESULTS: Histologic evaluation of sections of the surgically removed lesion revealed a concentric, periluminal proliferation of cells with prominent positive smooth muscle actin immunoreactivity. These findings are consistent with the diagnosis of a myopericytoma, a lesion not previously reported in the spine. CONCLUSIONS: This study shows the presence of a lesion in the thoracic spine only previously described in the soft tissue of the extremities. The diagnosis of myopericytoma should be included, along with hemangiopericytoma, in the differential diagnosis of lytic lesions of the spine.
Aged↗
Pediatric spinal deformity.
Pediatric spinal deformity is a common problem facing the pediatrician and orthopedic surgeon. Most commonly seen is idiopathic scoliosis. Early diagnosis and treatment are important. Although the etiology of idiopathic scoliosis remains unclear, there continues to be a search for genetic markers and studies for the modes of inheritance. Idiopathic scoliosis is more clearly understood recently and is recognized as a complex three-dimensional deformity. Prognostic indicators for juvenile scoliosis have been identified. Surgical management of idiopathic scoliosis continues to evolve, and now a thoracoscopic endoscopic technique is available. Long-term follow-up has demonstrated generally satisfactory results with spinal fusion surgery. Other syndromes such as Klippel-Feil, familial dysautonomia, and Marfan syndrome demonstrate high rates of scoliotic deformities. Most are unresponsive to bracing and most often require surgical intervention. Although primary spinal neoplasms are uncommon, most are benign, and outcomes are generally satisfactory.
Braces↗
A slow growing mass on the back in a 63-year-old man.
Explore the source record for details and available documents.
Disease Progression↗
Massive intestinal hemorrhage resulting from a polypoid tumor in the sigmoid colon: an unusual complication of a giant cell tumor of the fifth lumbar vertebra.
STUDY DESIGN: Clinicopathologic study of a case of giant cell tumor of the spine. SUMMARY OF BACKGROUND DATA: Giant cell tumors of the spine are uncommon, accounting for 1.3-6.5% of all cases in various series. Because of their location, they may cause neurologic deficits. The treatment consists of excision or curettage and has been claimed to give good results. METHODS: A 33-year-old woman presented with low back pain in 1995; radiologic investigation and biopsy showed features of giant cell tumor involving the fifth lumbar and first sacral vertebrae. Wide excision was performed, but the tumor recurred in 1996 and was curetted. She developed massive intestinal bleeding in 1997 resulting from infiltration of the sigmoid colon by giant cell tumor in the form of a polypoid intraluminal mass. The involved segment of colon was resected, and the patient remained alive, although debilitated, 7 years after initial presentation. RESULTS: Examination of the tumor in the spine and the colon showed typical histology of giant cell tumor with no evidence of malignant transformation. The involved colon was freely mobile and away from the tumor of the spine. CONCLUSION: Giant cell tumor of the spine can result in unusual complication, massive intestinal hemorrhage in our case, which causes considerable morbidity.
Adult↗
Iatrogenic intraspinal epidermoid tumor: two cases and a review of the literature.
STUDY DESIGN: Two cases of patients whom intraspinal epidermoid tumors presented and were successfully removed 6 years after neonatal lumbar puncture are reported. OBJECTIVE: To describe the presentation of this type of spinal tumor and strategies for diagnosis and treatment. SUMMARY OF BACKGROUND DATA: Cells iatrogenically implanted into the spinal canal during lumbar puncture can slowly grow until symptomatic. Diagnosis can be difficult and is often delayed. MRI appears to offer some advantages in diagnosis provided that gadolinium is used. Treatment is by surgical excision. METHODS: The first patient, a 6-year-old boy, presented with severe episodic hip pain of unknown etiology. MRI of the lumbar spine revealed a 1-cm epidermoid at L1-L2. The second child, a 6-year-old girl, presented with low back pain and dragging of the feet. MRI revealed a mass at L3. RESULTS: In both cases, complete excision via lumbar laminectomy was performed. Both patients were asymptomatic at the 1-year follow-up with resolution of preoperative weakness. CONCLUSIONS: This study highlights an uncommon but not rare tumor that may present to the spine specialist in a variety of ways. The diagnosis is often delayed. The advent of MRI has improved the ease and accuracy of diagnosis. Complete excision is usually possible and is curative.
Carcinoma, Squamous Cell↗
Single versus separate registration for computer-assisted lumbar pedicle screw placement.
STUDY DESIGN: This is a retrospective study conducted to evaluate the efficacy of single versus separate registration in assessing the pedicle screw accuracy in the computer-assisted lumbar spinal instrumentation. OBJECTIVES: To see if separate registration reduced lumbar pedicle screw misplacement. SUMMARY OF BACKGROUND DATA: Computer-assisted spinal instrumentation has been shown to improve pedicle screw installation accuracy, but 2.7% to 8% of screws still perforate the pedicular cortex. Suspected causes include differences in lumbar lordosis between preoperative CT scans and surgery. METHODS: Postoperative radiographs and CT scans were used to assess the accuracy of pedicle screw placement in 47 adult patients following computer-assisted lumbar spinal instrumentation. Twenty-two patients underwent single registration at one level, while the other 25 underwent registration at each level. RESULTS: The time required for a registration procedure on one level was 6 to 8 minutes, while the time required for application of a pedicle screw using computer-assisted techniques was an additional 6 to 10 minutes. The total number of screw placements was 118 in the single registration group and 130 in the separate registration group. In the former group, 85 (72%) pedicle screw placements were categorized as good, 28 (24%) were fair, and 5 (4%) were poor. All five poorly placed screws were placed in the lower lumbar or upper sacral spine with high mobility, and at levels without registration, with one causing root injury. In the latter group, 117 (90%) pedicle screw placements were good and 13 (10%) were fair. The difference in placement was found to be statistically significant (chi2, P = 0.0003). CONCLUSION.: Before the intraoperative real-time CT imaging is widely used, separate registration at each instrumented level during traditional computer-assisted lumbar spinal instrumentation is necessary to enhance the accuracy of screw placement.
Adult↗
Recovery of neurologic function following nontraumatic spinal cord lesions in Israel.
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess neurologic recovery and the manner in which it is affected by various factors following nontraumatic spinal cord lesions (NTSCLs). SUMMARY OF BACKGROUND DATA: NTSCLs comprise a considerable portion of spinal cord lesions. However, information about neurologic recovery in these lesions is scarce. METHOD: The study sample included 1,085 patients with NTSCL treated between 1962 and 2000 at the premier referral hospital for rehabilitation in Israel. Demographic and clinical data were collected from hospital charts. The degree of neurologic recovery was determined by comparing each patient's Frankel grades of neurologic deficit at first admission to rehabilitation and at discharge from the same hospitalization. The study population was also compared with previously studied 250 patients with traumatic spinal cord lesions (TSCLs). RESULTS: Complete or substantial neurologic recovery (upgrade to Frankel Grade D or E) occurred during rehabilitation in 51% of patients who were Grade A, B, or C on admission, and in 57% of those who were Grade C. Neurologic recovery in NTSCL during rehabilitation was significantly affected by initial Frankel grade and by NTSCL etiology. Age had a borderline effect. Gender, lesion level, and the decade of rehabilitation did not affect recovery. Recovery rate was usually higher in NTSCLs than in TSCLs. CONCLUSIONS: The prognosis for neurologic recovery is affected mainly by SCL severity and etiology, and is usually better in NTSCLs than in TSCLs.
Adolescent↗
Paget sarcoma of the spine: Scottish Bone Tumor Registry experience.
STUDY DESIGN: Retrospective case study of 13 cases of Paget sarcoma of the spine accrued from a prospectively collected Tumor Registry database. OBJECTIVES: To analyze the clinical, radiologic, and histologic features of Paget sarcoma of the spine and to determine the factors influencing the prognosis. SUMMARY OF BACKGROUND DATA: Paget disease of bone is a common disorder with the spine being involved in over 50% of patients. However, sarcomatous degeneration in the vertebral column is an extremely rare complication. There is very little in the literature with regard to clinical presentation and prognosis of patients with Paget sarcoma affecting the vertebral column. METHODS: Between January 1944 and December 2003, 89 patients were registered with a diagnosis of Paget sarcoma in the Scottish Bone Tumor Registry. Thirteen patients with Paget sarcoma of the spine were analyzed with regard to their clinical, radiologic, and histopathologic features along with the prognostic predictors. RESULTS: The mean age was 66.9 years (range: 56-79 years). There were 10 males and three females. There were seven cases involving the sacral spine (63.6%), three cases involving lumbar vertebrae, two affecting the dorsal spine, and one with diffuse dorsolumbar involvement (D11-L3). The mode of presentation was progressively increasing low back pain (in all 13), unilateral sciatica (six; left-sided, five; right-sided, one), bilateral sciatica (two), lower limb weakness (eight), and autonomic dysfunction (four). Ten of 13 cases (76.9%) were osteosarcoma. The rest were chondrosarcoma (n = 1), fibrosarcoma (n = 1), and malignant fibrous histiocytoma (n = 1). Decompression laminectomy was performed in three patients with progressive neurologic deficit. Eight patients had received radiotherapy. The mean survival was 4.22 months. CONCLUSIONS: This series confirmed that Paget sarcoma of the spine has a very poor prognosis. We found a constellation of symptomatology in patients with sarcomatous Paget spine resulting from radiculomedullary compression, primarily lumbosacral involvement and predominantly osteosarcomatous histology. There was no significant difference observed on the overall prognosis of the patients with Paget sarcoma of the spine in the last 6 decades.
Adult↗
Osteochondroma of the sacrum: a case report and review of the literature.
STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To describe the en bloc excision and postoperative outcome of an osteochondroma of the sacrum compressing the neural elements, as well as review the literature on solitary osteochondroma involving the sacrum. SUMMARY OF BACKGROUND DATA: Osteochondroma is the most common primary benign bone tumor. However, this tumor rarely involves the spine and even more rarely involves the sacrum. To the best of our knowledge, en bloc excision of a solitary osteochondroma of the sacrum has not been previously reported. METHODS: An 11-year-old male presented with disabling radicular pain in the right lower extremity. Radiologic studies showed a lesion occurring from the sacral lamina that was compressing the S2 nerve root. The tumor was excised en bloc through a posterior approach. The cavitary defect within the sacrum was reconstructed with crushed cancellous allograft and demineralized bone matrix putty. A literature review of solitary sacral osteochondroma was conducted of the English-based medical literature. RESULTS: Histologic studies showed the tumor to be an osteochondroma. After surgery, pain was completely relieved, and neurologic function was normal. At the last follow-up, the sacroiliac joint remained intact, and there was no evidence of local recurrence. A literature review revealed 4 previous cases addressing osteochondroma of the sacrum. CONCLUSIONS: Osteochondroma is a rare primary benign bone tumor that can occur in the sacrum. Local contamination and, therefore, the likelihood of local recurrence, are decreased when an en bloc, as opposed to an intralesional, excision is performed.
Child↗