European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Rosai-Dorfman disease (RDD) is an uncommon benign histiocytic proliferative disorder commonly involving the cervical lymph nodes and less frequently extranodal sites, including, rarely, the central nervous system, mainly intracranially. Spinal involvement is unusual. RDD is characterized by pathognomonic histopathological features, which are decisive in the definitive diagnosis. We present the case of a 75-year-old lady who presented with an isolated thoracic vertebral lesion. She underwent 3 CT-guided biopsies, all not confirmative for a definite diagnosis, and 2 open biopsies and debulking of the lesion. ⋯ This case demonstrates the challenge in making a diagnosis. RDD should be considered as a differential diagnosis in case of spinal lesion and non-diagnostic biopsy, especially in steroid sensitive lesions. The implications of the case are discussed.
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XLIF is an increasingly popular procedure that requires traversing the psoas, with the potential risk of injuring the lumbar plexus nerves. Intraoperative neurophysiological monitoring (IOM) is, therefore, critical in this kind of procedures; nevertheless, there were some reports of neural damage. ⋯ A detailed IOM of lumbar plexus branches can determine in real time the proximity of intrapsoas nerves during XLIF.
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The objective of this study was to investigate the outcome of a case series of patients with dysphagia resulting from diffuse idiopathic skeletal hyperostosis (DISH) of the cervical spine who were treated surgically with resection and fusion. ⋯ Diffuse idiopathic skeletal hyperostosis may lead to osteophyte-associated pathologies of the aerodigestive tract. Preoperative investigations with esophageal and laryngoscopic examinations combined with fluoroscopic swallowing tests are essential. Surgical decompression through osteophytectomy and fusion is an effective management strategy in selected patients and should be considered when non-operative strategies have failed.
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While correction surgery for syringomyelia-associated scoliosis frequently results in an elongation of the spine and may potentially influence the natural history of syringomyelia, a paucity of data exists regarding the syrinx behavior in the postoperative course. This study aimed to investigate the natural evolution of syrinx in patients undergoing one-stage posterior instrumented spinal fusion for treatment of scoliosis associated with idiopathic syringomyelia (IS). ⋯ For treatment of scoliosis associated with IS in the setting of minimal neurological deficits, one-stage spinal fusion with a lengthening of the vertebral column provides an effective coronal and sagittal correction without neurologic complications. Following surgery, the vast majority (95.5%) of syringes shrank or remained stable, indicating that deformity correction did not exert a deleterious effect on the natural evolution of syringomyelia.
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Case Reports
Five-level cervical corpectomy for neurofibromatosis-associated spinal deformity: case report.
To describe a successful five-level cervical corpectomy and circumferential reconstruction in a patient with a plexiform neurofibroma causing a severe kyphotic deformity. ⋯ Five-level cervical corpectomy including C2 can be safely and successfully performed via a transmandibular, circumglossal approach. Circumferential reconstruction utilizing a custom anterior titanium cage and plate system manufactured from a pre-operative CT scan was utilized in this case. Long segment occipital-cervical-thoracic reconstruction is recommended in such a case. Using such a technique, improvement in myelopathy, correction of deformity, and improved quality of life can be achieved.