• Wes Jackson, Anil Sethi, Julia Carp, Gary Talpos, and Rahul Vaidya.
• Orthopedic Foundation, Houston, TX, USA.
• Spine. 2007 Sep 1; 32 (19): E557-60.

Study DesignCase report.ObjectivesTo describe an unusual spinal manifestation of secondary hyperparathyroidism in a 29-year-old woman and discuss the pathologic basis of the disease and evaluate the response to treatment.Summary Of Background DataExtraskeletal tumoral calcification (i.e., tumoral calcinosis, tumoral calcinosis-like lesion, calcifying pseudoneoplasms) is an uncommon entity associated with secondary hyperparathyroidism. Involvement of the cervical spine with this tumor causing neural compression is extremely rare. Only a few cases have been reported in literature and none with a concomitant presence of brown tumors.MethodsA 29-year-old woman presented with upper back pain with tingling and weakness in the left hand. She had been on dialysis for 5 years following renal failure. She had a partial parathyroidectomy for hyperparathyroidism a year ago. Para vertebral calcification eroding the posterior elements of C6-T2 and abutting the dura and neural foramens was seen on a CT scan. There were numerous lytic defects of the thoracic and lumbar vertebral bodies, most notable at L4, suggesting focal brown tumors. An MRI scan of the spine demonstrated a large heterogeneously hypointense lesion of the cervicothoracic spine, which remained hypointense on T2 images. A cervicothoracic decompression and spinal stabilization from the front and back was performed. A pathologic diagnosis of tumoral calcinosis-like lesion was confirmed.ResultFollowing surgery, the patient recovered neurologically and subsequently underwent total parathyroidectomy. Presently, her bone lesions have healed.ConclusionHyperparathyroidism may cause tumoral calcinosis-like lesions in the spine. An early spinal decompression followed with parathyroidectomy leads to remission of symptoms.

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