Rare Case of a Solitary Spinal Osteochondroma with Myelopathy Treated by a Minimally Invasive Technique
Volume 2 | Issue 2 | October 2021-March 2022 | page: 98-101 | Umesh Srikantha, Akshay Hari, Yadhu Lokanath, Ravi Gopal Varma, Nandeesh BM
DOI: 10.13107/bbj.2022.v02i02.029
Authors: Umesh Srikantha [1], Akshay Hari [1], Yadhu Lokanath [1], Ravi Gopal Varma [1], Nandeesh BM [2]
[1] Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India.
[2] Department of Neuropathology, NIMHANS, Bangalore, Karnataka, India.
Address of Correspondence
Dr. Akshay Hari,
Consultant Spine Surgeon, Aster CMI Hospital, Bangalore, Karnataka, India.
E-mail: aksayhari@gmail.com
Abstract
Among primary bone tumors, osteochondroma or osteocartilaginous exostosis is a common occurrence. However, solitary spinal osteochondromas are quite rare, seen in only in 1–4% of all reported cases. Only few symptomatic cases have been reported so far in the literature. Recurrence and malignant transformation are also known, thereby necessitating wide surgical excision as the treatment of choice. We would like to report one such a case of a solitary cervical osteochondroma presenting with myelopathy that was excised surgically using a minimally invasive tubular approach.
Keywords: Spinal, Osteochondroma, Solitary, Myelopathy, Minimally invasive, Tubular
References
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19. Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Giant invasive spinal schwannomas: Definition and surgical management. J Neurosurg Spine 2001;94:210-5.
| How to Cite this Article: Srikantha U, Hari A, Lokanath Y, Varma RG, Nandeesh BM | Rare Case of a Solitary Spinal Osteochondroma with Myelopathy Treated by a Minimally Invasive Technique | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 98-101. |
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Removal of Intradural Extramedullary Schwannoma at Lumbar Level by Doing Laminoplasty in Paediatric Patient- A Case Report and Review of Literature
Volume 2 | Issue 1 | April-September 2021 | page: 52-55 | Rohit Thaker, Arvind Gosai, Pratik Shah
Authors: Rohit Thaker [1], Arvind Gosai [1], Pratik Shah [1]
[1] Department of Spine Surgery, OrthoPlus Hospital, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Rohit Thaker,
Consultant Spine Surgeon, OrthoPlus Hospital, Ahmedabad, Gujarat, India.
E-mail: thakerrohit@gmail.com
Abstract
Intradural Extramedullary tumour of thoracolumbar spine has been mainly treated with laminectomy till date. Other approach has been of treating this pathology by doing laminoplasty. Objective of this case presentation is that laminoplasty is better option for IDEM in selected cases. Laminectomy has been associated with many complications which can be avoided by doing laminoplasty such as postoperative spinal instability, epidural fibro¬sis, kyphotic deformity, excessive blood loss, hematoma invasion, progressive myelopathy, persistent back pain and prolonged hospital stay. So laminoplasty has clearly advantage compared to laminectomy in preserving posterior arch of the spine. Revision surgery is also easier when primary surgery has been done by laminoplasty. In our case of 13-year-old boy having Intradural Extramedullary Schwannoma at L3 level, he was treated with flipping laminoplasty and tumour excision. At final follow up he was having complete clinical recovery and fully healed laminoplasty assessed with CT scan without any recurrence of tumour or any spinal deformity. It proves our purpose of doing laminoplasty with better outcome compared to laminectomy.
Keywords: Laminoplasty; Laminectomy; Intradural Extramedullary; Spinal Cord Tumour.
References
1. Arnautovic K, Arnautovic A. Extramedullary intra¬dural spinal tumors: a review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci 2009;9 Suppl 1:40-5.
2. Aghayev K, Vrionis F, Chamberlain MC. Adult in¬tradural primary spinal cord tumors. J Natl Compr Canc Netw 2011;9:434-47.
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4. Mayfield FH. Complications of laminectomy. Clin Neurosurg 1976;23:435-9.
5. Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminecto¬my in children and adults. J Neurosurg 1982;57:441- 5.
6. Kumar R, Debbarma I, Boruah T, et al. Flipped Reposition Laminoplasty for Excision of Intradural Extramedullary Tumors in the Thoracolumbar Spine: A Case Series of 14 Patients. Asian Spine J. 2020;14(3):327-335. doi:10.31616/asj.2019.0034
7. Liu XY, Zheng YP, Li JM. Laminoplasty for the treat¬ment of extramedullary intradural tumors in the tho¬racic and lumbar spine: greater than two-year follow-up. Orthop Surg 2009;1:275-9.
8. Wiedemayer H, Sandalcioglu IE, Aalders M, et al. Reconstruction of the laminar roof with miniplates for a posterior approach in intraspinal surgery: technical considerations and critical evaluation of follow-up results. Spine, 2004, 29: E333–E342.
9. Papagelopoulos PJ, Peterson HA, Ebersold MJ, et al. Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine, 1997, 22: 442–451.
10. Yeh JS, Sgouros S, Walsh AR, et al. Spinal sagittal malalignment following surgery for primary intramedullary tumours in children. Pediatr Neurosurg, 2001, 35: 318–324.
11. Yücesoy K, Crawford NR. Increase in spinal canal area after inverse laminoplasty: an anatomical study. Spine, 2000, 25: 2771–2776.
12. Onyia, Chiazor & Menon, Sajesh. (2018). Laminectomy Versus Laminoplasty in the Surgical Management of Long-Segment Intradural Spinal Tumors: Any Difference in Neurological Outcomes?. Asian Journal of Neurosurgery. 13. 1128. 10.4103/ajns.AJNS_67_18.
| How to Cite this Article: Thaker R, Gosai A, Shah P | A Removal of Intradural Extramedullary Schwannoma at Lumbar Level by Doing Laminoplasty in Paediatric Patient- A Case Report and Review of Literature | Back Bone: The Spine Journal | April-September 2021; 2(1): 52-55.
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Atypical Fracture of Axis With False Localising Sign
Volume 2 | Issue 1 | April-September 2021 | page: 48-51 | G D Tharadara
Authors: G D Tharadara [1]
[1] Department of Orthopaedics, Saviour Hospital, Navrangpura, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. G.D. Tharadara,
EX. Professor of Orthopaedics, Spine Consultant, Saviour Hospital, Navrangpura, Ahmedabad, Gujrat, India.
E-mail: drtharadara@rediffmail.com
Abstract
Introduction: Injuries of upper cervical spine many times associated with false localizing signs as a neurological deficit means there is a no clinic-radiological correlation. Purpose of this case report is to diagnose rare clinical presentation due to injury of pyramidal tract decussating at lower medulla.
Method and Materials: A 21 years old male patient presented with traumatic quadriplegia (Frankel-A). Primary treatment was given along with immobilization of neck with collar. Routine X-ray of cervical spine was taken. X-ray was showing shear fracture of C 2 vertebra with intact dens. Crucified tong was inserted. Methyl Prednisolon injection in proper dose within 8 hours was given. (NASCIS II)
CT SCAN was done to know exact fracture geometry. It was showing a fracture of C2 body in an oblique plane shearing off in one piece with the dens tilted towards right side and with subluxation of C1-C2 articular process on left side.
Clinically patient improved in 24 hours in form of 4/5 power grade in all limbs except left upper limb. Left upper limb shoulder and elbow muscle power was grade 2/5 and o/5 in hand. Bladder/bowel was improved. Even though there was a weakness of left upper limb, but reflexes were preserved remarkably (Cruciate paralysis as a false localizing sign).
Considering atypical unstable fracture, open indirect reduction of C-1-2 done from posteriorly and stabilization done with apofix clamps after fusion between C1-C2 posterior arches.
Result: Patient had Frankel grade-A on admission. At three months follow up patient had almost full neurological recovery except finger grip power grade was 4/5. On final follow up at 12 months, neurology improved to Frankel grade-E. He had no neck pain with mild restriction of rotation. X-ray of cervical spine in flexion-extension shows stability and fusion of C1-C2 posterior elements.
Conclusion: Atypical clinical presentation like cruciate paralysis as a false localizing sign should be kept in mind while dealing with fracture of upper cervical spine. As this fracture has good prognosis, proper treatment is needed. If close reduction is not achieved then open reduction and stabilization with fusion will provide early mobilization and faster neurological recovery.
Keywords: Fracture; Axis; Cruciate; Paralysis.
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8. False Localizing Signs in Upper Cervical Spinal Cord Compression.William J. Sonstein, M.D., Patrick A. LaSala, M.D., W. Jost Michelsen, M.D., Stephen T. Onesti, M.D. Neurosurgery, Volume 38, Issue 3, March 1996, Pages 445–449, https://doi.org/10.1097/00006123-199603000-00004
9. J Neurosurg 73:850-858, 1990. Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction CURTIS A. DICKMAN, M.D., MARK N. HADLEY, M.D., CONRAD T. E. PAPPAS, M.D., PH.D., VOLKER K. H. SONNTA6, M.D., AND FRED H. GEISLER, M.D., PH.D.
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| How to Cite this Article: Tharadara GD | Atypical Fracture of Axis With False Localising Sign | Back Bone: The Spine Journal | April-September 2021; 2(1): 48-51. |
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