1/24. Percutaneous pediculoplasty in osteoporotic compression fractures. Percutaneous pediculoplasty is a vertebroplasty-complementary technique that can be carried out with one needle for each single approach. This report describes five cases of osteoporotic vertebral and pedicular compression fractures that were treated with percutaneous vertebroplasty and bilateral pediculoplasty with use of polymethylmethacrylate and high-quality fluoroscopic guidance. All patients reported complete pain relief. This is a safe, fast, and effective treatment for osteoporotic compression fractures with pedicle compromise. ( info) |
2/24. Histological evaluation of biopsies obtained from vertebral compression fractures: unsuspected myeloma and osteomalacia. STUDY DESIGN: A histological evaluation of biopsies obtained from presumed osteoporotic vertebral compression fractures (VCF) to confirm possible osteomalacia after tetracycline labeling. OBJECTIVE: To describe the results of a series of biopsies obtained at the time of vertebral augmentation in presumed osteoporotic VCF, with special reference to the presence of unmineralized bone (osteomalacia) and occult or unconfirmed plasma cell dyscrasia. SUMMARY OF BACKGROUND DATA: Vertebral augmentation is now widely performed as a method to treat osteoporotic or osteolytic VCF. However, the influence of underlying pathology on the effect of treatment is unclear. methods: As of October 2003, 178 biopsies were obtained from 142 patients with VCF during 246 kyphoplasty procedures. There were 110 one-level, 28 two-level, and 4 three-level biopsies. patients included 41 men and 101 women, with an average age of 72 years (range 40-90). The patients consented to this procedure, and 25 received tetracycline (1g/day, in 2 doses separated by 6 days). Vertebral body biopsies were taken using a trephine just before the kyphoplasty procedure. The biopsies were fixed, embedded, and stained with toluidine blue and hematoxylin eosin, and were viewed with transmitted light. Unstained sections were viewed under fluorescent light to detect tetracycline labels. RESULTS: The 178 biopsy levels included: T4 (3), T5 (1), T6 (4), T7 (13), T8 (12), T9 (8), T10 (11), T11 (17), T12 (28), L1 (25), L2 (14), L3 (13), L4 (17), and L5 (12). All specimens showed fragmented bone with variable amounts of unmineralized bone (osteoid), suggesting bone remodeling and/or fracture healing. Woven bone and cartilaginous tissue were often present, representing fracture callus formation. The biopsies obtained from 30 patients (21%), including 4 who received tetracycline, showed significantly increased osteoid, suggesting either increased bone remodeling activity or mineralization defect (osteomalacia). One sample from these 4 patients who received tetracycline showed no tetracycline labels, essentially diagnostic of osteomalacia. The biopsies also provided definitive diagnoses for one case of unsuspected and 3 cases of unconfirmed plasma cell dyscrasia. CONCLUSIONS: The majority of biopsies from this series of patients revealed findings consistent with various stages of fracture healing. Osteoid seams were increased in 30 patients, representing either increased bone remodeling or osteomalacia. More cases with tetracycline labeling will help elucidate the true incidence of osteomalacia in this population. As we confirmed 4 cases of plasma cell dyscrasia, we advocate a biopsy during each first-time vertebral augmentation procedure. ( info) |
3/24. Percutaneous vertebroplasty: a review for the primary care physician. The purpose of this article is to help primary care physicians who are often challenged with the management of vertebral compression fracture (VCF) by presenting clinical background and identifying candidates for percutaneous vertebroplasty, a minimally invasive procedure for treatment of VCF. ( info) |
| While several cases of cancer metastatic to cranial meningiomas have been reported, metastasis to spinal meningioma has been reported only once, and a mechanism for such metastases has not been investigated. We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summarize the literature on metastases to central nervous system meningiomas, and suggest a possible mechanism. Our patient, a 55-year-old woman, presented with difficulty walking, back pain, and quadriparesis. magnetic resonance imaging revealed an enhancing C3-4 epidural lesion and an L4 compression fracture. Because of concern that the fracture and epidural lesion might represent metastases, we performed a metastatic work-up, which revealed a right breast mass. The patient underwent C3-C4 laminectomies and an epidural lesion was encountered. Intraoperative frozen section revealed mixed meningioma and breast adenocarcinoma. A gross total resection was achieved and the patient subsequently received spinal irradiation and hormonal therapy. Whereas a literature review revealed numerous reports of metastases to cranial meningiomas, this represents only the second reported case of such pathology in the spine. Mechanisms of this unusual process likely include meningiomas' vascularity, meningiomas' slow growth providing nutrient availability, and perhaps, as suggested by our analysis, E-cadherin expression by both meningiomas and breast cancer. Metastasis to meningioma must be considered in an epidural spinal lesion in all patients with a known malignancy, with surgical aggressiveness tailored to the intraoperative pathologic diagnosis. ( info) |
5/24. Minimally incisional stabilization of unstable L5 burst fracture. BACKGROUND: Burst fractures of the L5 vertebral body are uncommon. Treatment options described include prolonged immobilization and surgical stabilization, most commonly with an instrumented fusion from L4 to the sacrum. methods: We describe the use of a minimally incisional technique to provide temporary internal fixation in a patient with an L5 burst fracture who was not a candidate for prolonged immobilization. RESULTS: This technique resulted in an excellent outcome without the requirement for a fusion. CONCLUSION: Minimally incisional fixation procedures are a treatment option for select patients with L5 burst fractures. ( info) |
6/24. Multiple intracranial calcifications and spinal compressions: rare complications of type la pseudohypoparathyroidism. Type la pseudohypoparathyroidism (PHP la) is an unusual inherited disease. PHP la often causes extraskeletal calcifications and even soft tissue ossifications. patients may present neurologic symptoms and signs related to hypocalcemia and hyperphosphatemia. We report here a 38-yr-old woman with PHP la who had two uncommon neurologic complications. One was involuntary movements related to basal ganglia calcification, and the other was myelopathy owing to ossifications of the posterior longitudinal ligament and multiple herniated intervertebral disks. Aggressive body weight control and corrections of hypocalcemia, hyperphosphatemia, and elevated PTH may be important to prevent these unusual neurologic complications. Regular and careful neurologic examinations should be performed for early diagnosis and treatments of these spinal lesions. ( info) |
7/24. Intraspinal leakage of bone cement after vertebroplasty: a report of 3 cases. We report 3 cases of vertebroplasty-induced intraspinal leakage of bone cement that were referred to us for management. Two patients received decompressive surgery, and one received rehabilitation. The gross surgical finding of yellowish dura mater and intradural fibrosis, adhesion, and microscopic finding of arachnoid membrane fibrosis are suggestive of late effect of thermal injury. These patients had residual lower extremity weakness and urinary and stool problems 13 months, 3 years, and 4.75 years post-vertebroplasty, respectively. ( info) |
8/24. Fatal fat embolism after vertebroplasty: identification of the high-risk patient. We report a rare complication of autopsy-proven fat and bone marrow embolization following percutaneous vertebroplasty in a patient who had no evidence of cement leakage. Cement injection was done during one patient encounter, covering 3 vertebral levels by using a unipedicular approach. patients may have complications even without polymethylmethacrylate leakage. ( info) |
9/24. Percutaneous sacroplasty using CT fluoroscopy. Sacral insufficiency fractures frequently cause significant pain and limit activities of daily living in patients with osteoporosis. Percutaneous vertebroplasty is a common procedure to alleviate the pain associated with thoracic and lumbar vertebral compression fractures. The sacral percutaneous vertebroplasty procedure (sacroplasty) has recently been introduced as an alternative to medical management of osteoporotic sacral insufficiency fractures. We describe our CT fluoroscopy technique in performing percutaneous sacroplasty. ( info) |
10/24. Spinal epidural extraskeletal Ewing sarcoma in an adolescent boy: a case report. Extraskeletal Ewing sarcoma (EES) represents a rare soft tissue malignant neoplasm histologically similar to skeletal Ewing sarcoma. It occurs mainly in adolescents and young adults and commonly affects the paravertebral regions. The differential diagnosis includes other small, blue round cells tumors. The authors report a case of an EES involving the spinal epidural and paravertebral spaces in an adolescent boy. EES diagnosis was confirmed by features of histologic analysis and immunohistochemistry and by the presence of the t(11;22)(q24;q12) chromosomal translocation by reverse transcriptase-polymerase chain reaction. ( info) |