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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Review Case Reports
Aneurysmal bone cyst of the spine treated by concentrated bone marrow: clinical cases and review of the literature.
ABC is a benign lesion with unpredictable behavior. Its treatment is challenging, especially in poorly accessible surgical areas, such as spine and pelvis. Currently, the first-line treatment of ABC is repeated selective arterial embolization (SAE) until healing. Other options have been used with variable success rates. We propose an alternative treatment for spine aneurysmal bone cyst (sABC) based on the injection of concentrated autologous bone marrow. ⋯ Although SAE can still be considered the first line in the treatment of ABC in the axial skeleton, new promising therapeutic procedures involving the use of mesenchymal stem cells are developing.
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Review Case Reports
Primary intramedullary hydatid cyst: a case report and literature review.
Intramedullary hydatid cyst is extremely rare. We present a case of pathologically confirmed primary intramedullary hydatid cyst in an otherwise healthy patient. A 17-year-old boy presented with lumbar pain, weakness, and numbness in both lower limbs, and urinate difficulty interrupted for 2 years. ⋯ An intramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal. Although extremely rare, primary intramedullary hydatid cyst pathology might be the cause of lumbar pain, weakness, and numbness in both lower limbs for those living in endemic areas. Surgical removement is feasible and effective for intramedullary hydatid cyst.
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Review Case Reports
Migratory low velocity intradural lumbosacral spinal bullet causing cauda equina syndrome: report of a case and review of literature.
Migration of the bullet within the spinal subarachnoid space has long been recognized as unusual complication of spinal gunshot injury. ⋯ Caudal migration of the bullet within the lumbosacral subarachnoid space results in cauda equina syndrome. Surgical retrieval of the bullet ensures the early recovery of neurological symptoms. Prone patient positioning can influence bullet location. Intraoperative fluoroscopy prior to skin incision is essential in addition to preoperative imaging to locate the bullet and thus avoid incorrect lower level laminectomy. Trapping the bullet after durotomy using suction and dissector in reverse Trendelenburg position is a useful aid in bullet removal.
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Axial fractures in patients with a previous C2-pelvis posterior instrumented fusion are rare and may be challenging to manage. Motion preservation in the axial spine for these patients is important, as the C1-2 and Occipit-C1 joints are their only remaining mobile spinal segments. In this unique report, we present for the first time the use of a fusionless occipitocervical operation for the treatment of a type II odontoid fracture and unilateral C2 pars fracture adjacent to a previous C2-pelvis posterior instrumented fusion. ⋯ In this one patient, instrumentation without fusion allowed for successful and timely union of a displaced odontoid fracture in a patient with a previous C2-pelvis fusion. Axial range of motion was preserved after instrumentation removal.
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Case Reports
Giant cell tumor of the thoracic spine completely removed by total spondylectomy after neoadjuvant denosumab therapy.
Denosumab, a novel monoclonal antibody that targets the receptor activator of nuclear factor-κB (RANK) ligand (RANKL), has recently been used to treat patients with giant cell tumor of bone (GCTB). However, few reports have described the clinical results of denosumab therapy for spinal GCTB and evaluated treatment efficacy with respect to the entirety of the resected vertebra after denosumab therapy. ⋯ These findings support that GCTB stromal cells survived around the newly formed woven bone after long-term denosumab treatment and total surgical resection of such primary spinal lesions as the gold-standard treatment, even following administration of denosumab. Surgeons should note that prolonged adjuvant denosumab therapy may increase the difficulty of performing a posterior-approach total en bloc spondylectomy.