Myelopathy in a 16-year-old girl

Journal of Neurosurgery: Pediatrics, 2006

Object. Tumors originating in the vertebrae in children are difficult to treat. In this paper the authors sought to evaluate the decision-making process and outcome of surgical intervention in this population given the complex issues of spinal stability, continued skeletal growth, intraoperative blood loss, and long-term outcome. Methods. To select patients for this study, the authors retrospectively reviewed medical records and images at the University of Iowa Hospitals and Clinics between 1996 and 2005. Their inclusion criteria were age younger than 18 years at the time of diagnosis and histopathological findings confirming that the tumor originated from vertebral bone. Sixteen patients met these requirements. In addition, the authors conducted a comparison with 45 patients in whom similar diagnoses were made prior to 1996. Gross-total resection of all nonmetastatic primary bone tumors is desired, as exemplified in 11 patients in this series; biopsy sampling only was performed in two others. Gross-total resection was also not performed in three patients with eosinophilic granuloma (EG). These three patients underwent nonsurgical treatment, which is different from how patients with EG were treated in the earlier study. Nine histopathological diagnoses were included; with a mean follow-up period of 3.7 years, the survival rate is 94%. The tumor recurred in one patient with a giant cell tumor of the sacrum. The authors performed preoperative tumor embolization and found that it was a useful adjunct to resection. Provocative testing prior to embolization was part of the protocol to reduce ischemic complications. Motion-sparing surgical procedures were performed in which a few segments were fused, preserving axial mobility. Conclusions. Overall, early intervention offers the best symptomatic relief, which can only be rendered if sufficient clinical suspicion provokes early diagnostic imaging.

BMC Musculoskeletal Disorders, 2023

Background Langerhans cell histiocytosis (LCH) is a rare disorder. The treatment options vary depending on how many organs are involved and how extensive the disease is. In this report, a case of LCH with isolated 6th cervical vertebra (C6) collapse was presented. This case was treated with anterior corpectomy and instrumented fusion, followed by local radiotherapy (RT), with a good clinical outcome up to postoperative six months. Case presentation This was a 47-year-old female patient with a complaint of neck pain and bilateral shoulder pain for two months before consultation. She was initially treated with analgesics, but the pain was persistent. Further radiological evaluations revealed an osteolytic lesion within the C6 vertebral body with a pathological fracture. Magnetic resonance imaging (MRI) with contrast of the cervical spine revealed diffused hypointense signal changes on the T1-weighted images and hyperintense signal changes on the T2-weighted images in the C6 vertebral body, with significant contrast-enhanced infiltration signals. Furthermore, in positron emission tomography-computed tomography (PET-CT), focal hypermetabolism and abnormal uptake signals were seen only in the C6 vertebral body. The patient underwent an anterior cervical corpectomy with instrumented fusion. The histopathological results confirmed the diagnosis of LCH. The patient reported significant pain relief on postoperative day one. Moreover, she was treated by local RT at postoperative one month. Good clinical outcomes were achieved in the form of no pain and recovery in neck mobility up to postoperative six months. No evidence of recurrence was observed at the final follow-up. Conclusions This case report describes a treatment option for a solitary C6 collapse with LCH managed by anterior corpectomy and instrumented fusion, followed by local RT, with a good clinical outcome at postoperative six months. More studies are needed to elucidate whether such a treatment strategy is superior to surgery or RT alone.

BMJ case reports, 2014

We report the case of a 60-year-old woman who presented to accident and emergency with left arm and neck pain. She had reported these symptoms to her general practitioner over the preceding weeks but no imaging was obtained. Radiographs revealed a pathological lesion in her left humerus. On review in the Orthopaedic Fracture Clinic radiographs of the cervical spine were obtained and showed complete destruction of the C4 vertebral body. She underwent corpectomy and stabilisation. Tissue diagnosis confirmed myeloma and she is now under the care of the haematologists receiving chemotherapy and radiotherapy. Myeloma is known to cause severe destructive lesions. Through the dramatic radiographic images this case serves as a reminder to clinicians to obtain imaging of patients with a new or existing diagnosis of malignancy, who show symptoms of skeletal pain, as lesions requiring emergency management may be present.

European Spine Journal, 2007

Percutaneous vertebroplasty (PVP) of the axis is a challenging procedure which may be performed by a percutaneous or a transoral approach. There are few reports of PVP at the C2 level. We report a case of unstable C2 fracture treated with the percutaneous approach. The fracture was the first manifestation of multiple myeloma in a previously healthy 47-year-old woman. After local radiotherapy and chemotherapy, the fracture was still unstable and the patient had been continuously wearing a stiff cervical collar for 9 months. Complication-free PVP resulted in pain relief and stabilization and use of the cervical collar could be discontinued. At 18 months follow-up the patient remained free from pain, the fracture was stable and she had returned to work. The purpose of this article is to present the technical facts and to highlight the benefits and potential complications of the procedure. The technical characteristics of the procedure, the indication and results of the present case are discussed together with previously reported cases of PVP treatment at C2.

European Journal of Orthopaedic Surgery & Traumatology, 2007

We report what we believe to be the Wrst case to be presented in the literature of a giant cell tumor (GCT) arising in the seventh cervical vertebral body in a girl of almost 10 years of age. The only similar-reported case occurred in the cervical spine of an adolescent. Cervical location of this tumour is rare: spinal cases usually arise in the lumbar or thoracic spine. The patient presented to the emergency department with the following neurological symptoms: reduction of tricipital reXex and lack of straight in the right upper limb. Radiographs revealed lysis of the C7 vertebral body with anterior subluxation of C7 on T1. Further investigations (MRI, CT scan, Total Whole Body Scintigraphy) showed neurovascular involvement (the vertebral artery and C7 and T1 nerve roots were incorporated within the tumoural mass) without secondary lesions. An open biopsy at C6-T1 level was performed; diagnosis was histological: mononucleated spindle cells and osteoclast-like multinucleated cells were identiWed. Treatment consisted of surgical resection, vertebral stabilisation and chemotherapy. Twenty-four months after surgical resection and chemotherapy, the girl is well without evidence of local or systemic recurrence. Radiation therapy was not performed to avoid the risk of secondary sarcomatous degeneration.

Journal of Medical Science And clinical Research, 2017

Primary osteosarcoma of cervical spine is a rare condition with poor prognosis .The clinical, radiological as well as histopathological features of osteosarcoma vary widely, often leading to diagnostic difficulties. The report highlights the rarity of osteosarcoma of the cervical vertebra wherein the radiological and clinical findings suggested an infective pathology and histological findings remained the gold standard for final diagnosis of neoplastic etiology. A 21-year-old female presented with pain in the nape of the neck and tingling numbness in left upper & lower limb. On examination patient had quadriparesis. Radiological investigations were suggestive of infective etiology most likely Koch's causing involvement of C3-C5 vertebrae with prevertebral, paravertebral, parapharyngeal and intraspinal infective soft tissues abscess. She underwent C4 laminectomy with excision of the lesion and C1-C7 fixation with titanium Hartshil. The patient eventually died in the post-operative period. The intraoperative squash diagnosis was reported as a spindle cell tumor with malignant potential. The subsequent neuropathological diagnosis of C4 vertebral tumor on paraffin sections revealed characteristic features of osteogenic sarcoma (osteoblastic variant) showing osteoblastic giant cells and neoplastic growth of atypical spindle shaped cells arranged in sheets and trabeculae laying down mineralized osteoid and permeating the adjoining host bone. Early detection and accurate diagnosis is important for improving not only patient prognosis but also the quality of life. We should always consider this rare entity, particularly in young patients who present with intractable neck pain.

Frontiers in Surgery, 2022

Background: Although osteosarcoma is the most common primary malignant bone tumor in children, its location in the axial skeleton is rare, particularly at the cervical spine. Early diagnosis, together with multidisciplinary management, improves survival rates. Safe resection and stable reconstruction are complicated by the particular anatomy of the cervical spine, which raises the risks. Case Presentation: A 12-year-old male patient presented with cervical pain for several months and a recent weight loss of 3 kg. The complementary workup revealed a large destructive bone lesion in C7 with vertebral body collapse, subluxation, partial involvement of C6 and T1, large associated anteroposterior soft tissue components, and spinal canal narrowing. A biopsy suggested giant cell-rich osteosarcoma (GCRO). After 10 cycles of neoadjuvant chemotherapy, surgical resection was performed through a double approach: anterior, for tumoral mass resection from C6-7 vertebral bodies and reconstruction placing a mesh cage filled with iliac crest allograft plus anterior plate fixation; and posterior, for C7 complete and C6 partial posterior arch resection, thus completing a total piecemeal spondylectomy preserving the dura intact, added to a C5-T3 posterior fusion with screws and transitional rods. Postoperative chemo and radiotherapy were administered. Clinical and radiological follow-up showed disease-free survival and no neurological involvement at 3 years. Conclusion: An extensive review of the literature did not find any published cases of GCRO of the cervical spine in pediatric patients. This can be explained by the combination of three peculiar conditions: its location at the cervical spine region, the young age, and the GCRO variant.

Neuroradiology, 2009

Introduction Spinal involvement is a common presentation of multiple myeloma (MM); however, the cervical spine is the least common site of myelomatous involvement. Few studies evaluate the results of percutaneous vertebroplasty (PV) in the treatment of MM of the spine. The purpose of this series is to report on the use of PV in the treatment of MM of the cervical spine and to review the literature. Materials and methods From January 1994 to October 2007, four patients (three men and one woman; mean age, 45 years) who underwent five PV for painful MM in the cervical spine were retrospectively reviewed. The pain was estimated by the patient on a verbal analogic scale. Clinical follow-up was available for all patients (mean, 27.5 months; range, 1–96 months). Results The mean volume of cement injected per vertebral body was 2.3 ± 0.8 mL (range, 1.0–4.0 mL) with a mean vertebral filling of 55.0 ± 12.0% (range, 40.0–75.0%). Analgesic efficacy was achieved in all patients. One patient had a spinal instability due to a progression of spinal deformity noted on follow-up radiographs, without clinical symptoms. Cement leakage was detected in three (60%) of the five treated vertebrae. There was no clinical complication. Conclusions The present series suggests that PV for MM of the cervical spine is safe and effective for pain control; nonetheless, the detrimental impact of the disease on bone quality should prompt close radiological follow-up after PV owing to the risk of spinal instability.

Археология Севера: памятники, проблемы, гипотезы, 2024

Небольшая серия кремневой антропоморфной скульптуры без рук известна на территории лесной зоны Восточно-Европейской равнины в контекстах поселений. На данный момент их датировка считается широкой: как минимум в рамках 3300–2800 cal BC, возможно, почти до конца III тыс. до н.э. Морфология и размеры предметов различны. В функциональном плане рассматриваемые скульптуры могут трактоваться как нашивные предметы или предметы, носившиеся с собой и принадлежавшие конкретным людям, которые могли намеренно прятать их или оставлять на поселениях.