Abstract
Monostotic fibrous dysplasia (MFD) of the lumbar spine represents an exceedingly rare lesion. A 26-year-old patient presented with a progressive osteolytic lesion of the vertebral body L2 and the diagnosis of MFD. A minimally invasive left-sided eXtreme Lateral Interbody Fusion (XLIF) approach with resection of the vertebral body L2 with placement of a mesh cage was performed. No complications were observed perioperatively and the symptoms rapidly improved. Minimally invasive piecemeal resection with a combined dorsolateral approach showed a favorable clinical and radiological outcome and seems to be a safe and reliable technique for MFD.
Highlights
Monostotic fibrous dysplasia (MFD) of the spine represents a rare disease entity of the lumbar spine [3, 5, 6, 19]
Concerning the vertebral level, Yu et al published a case report with a review of the literature in 2014, which revealed that the third lumbar vertebra (L3) was most commonly affected
The peak age for FD affects weighted and contrast-enhanced magnetic resonance images (MRI) dated 2018 showing a progression of the osteolytic mass with a compression fracture of the upper endplate with increasing central cover plate recess at the posterior margin, affecting the anterior and middle spinal column leading to instability
Summary
Monostotic fibrous dysplasia (MFD) of the spine represents a rare disease entity of the lumbar spine [3, 5, 6, 19]. FD is known as an uncommon mosaic disease, in which normal bone gets replaced by fibro-osseous tissue This bony remodification leads to a weakened osseous matrix prone to fractures and deformity with corresponding pain and functional impairment [8]. History and presentation In November 2018, a 26-year-old young man with deep-seated pain in the upper lumbar spine and the diagnosis of juvenile fibrous dysplasia of the vertebral body L2 was sent to our outpatient clinic. A SynMesh-Cage (DePuy-Synthes Spine, PA, USA), filled with bone harvested from the iliac crest and the resected twelfth rib, was performed. This was supplemented with demineralized bone matrix (GRAFTONTM DBM, Medtronic, Dublin, Ireland). The postoperative x-ray did not show loss of correction
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