Thoracic Spine Presenting Research Articles

Intramedullary Nocardiosis of the Cervical and Thoracic Spine Presenting With Progressive Upper-Extremity and Lower-Extremity Weakness: 2-Dimensional Operative Video.

Intramedullary Nocardiosis of the Cervical and Thoracic Spine Presenting With Progressive Upper-Extremity and Lower-Extremity Weakness: 2-Dimensional Operative Video.

Primary Malignant Lymphoma Presenting as an Isolated Epidural Mass.

Primary central nervous system lymphoma is a rare form of extranodal non-Hodgkin’s lymphoma that occurs in the brain, spinal cord, leptomeninges, or eyes and typically remains confined to the central nervous system. Among them, malignant lymphoma presenting as a primary tumor of the spinal cord is extremely uncommon, and epidural mass formation is known to occur in only 0.8–2.8% of cases of malignant lymphomas. Furthermore, primary malignant lymphoma presenting as an isolated epidural mass is much rarer. Here, we report a case of primary malignant lymphoma of the thoracic spine presenting as an isolated epidural mass that did not involve the vertebral body or posterior element. Surgical decompression is essential to prevent further neurological deterioration. Here, we present a successful treatment strategy for this rare case.

High-Grade Primary Osteosarcoma of the Thoracic Spine Presenting as an Ivory Vertebra

High-Grade Primary Osteosarcoma of the Thoracic Spine Presenting as an Ivory Vertebra

Giant cell tumour of dorsal spine presenting with mediastinal mass: a rare case report

Incidence of giant cell tumour (GCT) of spine above sacrum is rare. Moreover, involvement of posterior elements of spine is a rare entity. Furthermore, primary GCT arising at thoracic spine presenting as a huge mediastinal mass is extremely rare. Here, we are presenting a case of GCT presenting with posterior mediastinal mass. The case came to Orthopaedics outpatient department (OPD) with long-standing pain at the dorsal spine with features of depression. When chest X-ray was done, a posterior mediastinal mass at the level of D10 vertebra was detected. Magnetic resonance imaging (MRI) of the dorsal spine revealed a GCT involving body, left transverse process, and pedicle of the D10 vertebra. Computed tomography (CT)-guided biopsy from the posterior mediastinal mass and D10 vertebra was suggestive of GCT of dorsal spine.

Osteoblastoma of the thoracic spine presenting with back pain

A 22-year-old man presented with complaint of persistent back pain. His medical history and physical examination were unremarkable. Magnetic resonance imaging (MRI) revealed an expansile, circumscribed lesion (2×1.5×1.3 cm) located in the right inferior articular process and pedicle of the 10th thoracic vertebra (Fig. 1). It extended anteroinferiorly into the right neural foramen and lateral recess, causing compression of the spinal nerve at the T10–T11 levels (Fig. 2). It was mildly hypointense to muscles on T1-and T2weighted images. Surrounding intense soft tissue and bone marrow edema was also seen. The lesion was isodense to bone, without adjacent cortical erosion or sclerosis on computed tomography images. Enhancement of the lesion and the adjacent reactive edema were seen on post-contrast MRIs. Imaging findings were compatible with osteoblastoma. Surgical resection of the tumor was performed, and histologic examination revealed the diagnosis of osteoblastoma. No neurologic deficits were observed after surgery. Followup MRI at 3 months showed postoperative changes, but no residual tumor. There has been a significant reduction in the patient’s back pain. Osteoblastoma is a rare, benign primary bone tumor that is mostly located in the spine (40%), especially the posterior elements. Surrounding reactive bone marrow and soft tissue edema and enhancement can be seen [1].

Pseudomeningocele with spinal cord compression following removal of meningioma at the Th3-Th4 level: a case report

Pseudomeningocele is an abnormal extradural collection of the cerebrospinal fluid in soft tissues, communicating with the arachnoid space through a dural defect. Postoperative pseudomenigocele of the thoracic spine presenting with myelopathy is a rare phenomenon; we found only two such cases in the literature. A clinical case of a female patient operated on for meningioma at the Th3-Th4 level with postoperative pseudomenigocele and spinal cord compression is presented.

A Rare Hyperextension Injury in Thoracic Spine Presenting with Delayed Paraplegia

Hyperextension injury in the thoracic spine is uncommon with only a few cases documented in the literature. The mechanism of these injuries is hyperextension combined with axial or shearing force. These types of injuries are associated with a high risk of dural tears and paraplegia. A 91-year-old female presented with acute back pain from a hyperextension injury in thoracic spine with no neurological deficit. Lumbar magnetic resonance imaging showed a intervertebral disc rupture. On day 20 of hospitalization, the herniated intervertebral disc compressed the spinal cord with incomplete paraplegia. Hyperextension injuries involving the three columns are very unstable and we recommend surgical treatment as soon as possible, not only because of the initial trauma, but a ruptured disc herniation can damage the spinal cord.

Giant Cell Bone Tumor of the Thoracic Spine Presenting in Late Pregnancy

We report a case of a large giant cell tumor of the thoracic spine presenting with spinal cord compression during pregnancy. A 24-year-old woman presented at term with lower back pain, bilateral lower extremity weakness, numbness, and bowel and bladder incontinence. Magnetic resonance imaging revealed a spinal soft tissue mass compressing the spinal cord. The patient delivered a healthy girl by cesarean then underwent a T8-T9 laminectomy, posterior spinal decompression, and instrument fusion. Two days later, she had a thoracotomy, corpectomy of the vertebral body, and anterior tumor debulking. Ultimately, the patient was discharged to inpatient rehabilitation with improved lower extremity strength and returned bowel and bladder function. Obstetricians should be vigilant regarding progressive neurologic symptoms during pregnancy.

Spontaneous epidural hematoma of thoracic spine presenting as Brown-Séquard syndrome: report of a case with review of the literature

BackgroundSpontaneous spinal epidural hematoma (SSEH) is an uncommon clinical entity. It produces a severe neurological deficit and prompt decompression is usually the first choice of treatment. Brown-Séquard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm, but rarely caused by SSEH.MethodsCase report and literature review.FindingsA previously healthy man presented with Brown-Séquard syndrome below T5–T6 cord segment secondary to spontaneous epidural hematoma. He opted for conservative treatment, which was followed by rapid resolution.ConclusionsAlthough Brown-Séquard syndrome as a presenting feature of SSEH is rare, it does exist in exceptional case, which should be taken into consideration for differential diagnosis. Prompt surgical decompression is an absolute surgical indication widely accepted for patient with progressive neurological deficit. However, SSEH presenting with incomplete neurological insult such as Brown-Séquard syndrome might have a benign course. Successful non-operative management of this problem does not make it a standard of care, and surgical decompression remains the standard treatment for SSEH.

B-Cell Lymphoma of the Thoracic Spine Presenting with Spinal Cord Pressure Syndrome

B-cell lymphomas are the most common type (85%) of non-Hodgkin lymphomas [1]. Diffuse large B-cell lymphoma accounts for a third of these tumors and occurs mostly in older people [1]. NonHodgkin’s lymphomas arising in the spinal cord are extremely rare. Spinal cord compression as the initial manifestation of nonHodgkin’s lymphoma is rare and may occur in advanced stages of the disease [1-3]. It usually looks isointense or low signal (relative to the spinal cord) on T1-weighted images and high signal on T2weighted images [4]. Contrast enhancement is usually intense and homogeneous [4]. A 70-year-old African-American male presented to the emergency room complaining of bilateral mild lower extremity weakness for 2 days. The patient could not bear weight on his legs when he tried to get out of bed in the last two mornings. He also felt numb in both legs. Since then, he has been incontinent of urine but not feces. He denied any back pain or trauma. He also had no weakness or numbness in the upper extremities. His past medical history included chronic obstructive pulmonary disease and aortic regurgitation. He was on Zithromax and Prednisone at Home. He denied using alcohol, tobacco or elicit drugs. The patient had some wheezing and cough in addition to mild abdominal pain. On neurological exam, the patient had weakness in the lower extremities. The strength at the hip and knee was 2/5 on the right side and 3/5 on the left side and 1/5 at the ankle on both sides. Deep tendon reflexes were 2+ in the biceps and triceps symmetrically. His right knee jerk was 1+ and left knee jerk 2+ and both ankle jerks were abscent. He also had absence of position sense in both of his ankles and feet. He had a pinprick sensation at the nipple level (T4) both anteriorly and posteriorly. The initial diagnosis was acute spinal cord syndrome at T4 and the patient was put on Decadron. Thoracic MRI showed an epidural soft tissue mass at the T3, T4 and T5 levels extending from the posterior aspect of the spinal canal causing moderate encroachment upon the spinal cord at T4 with diffuse metastatic disease involving the cervical and lumbar vertebral bodies (Fig. 1-3). After consulting with the patient it was decided to proceed with T3, T4, T5 decompressive laminectomies and excision of tumor from epidural space under microscope. Microscopic examination revealed a diffuse proliferation of

Giant Cell Tumor of the Thoracic Spine Presenting as a Posterior Mediastinal Tumor with Benign Pulmonary Metastases: A Case Report

Giant cell tumor of bone is a benign, but potentially aggressive lesion that can show local recurrence and metastases. We report here on a case of a 29-year-old man who presented with an incidentally found mediastinal mass. Chest radiography and computed tomography showed a huge mediastinal mass with bilateral pulmonary nodules and the diagnosis of giant cell tumor with benign pulmonary metastasis was confirmed. To the best of our knowledge, this is the first reported case of primary thoracic spinal giant cell tumor manifesting as a huge mediastinal mass with pulmonary metastases.

Transitional Cell Carcinoma of the Upper Ureter Metastatic to the Thoracic Spine Presenting as a Spinal Cord Compression

We performed a left nephroureterectomy for a gentleman with transitional cell carcinoma of the upper ureter. Histological analysis revealed it to be a T1 lesion, but to be highly mitotically active. The gentleman defaulted on adjuvant therapy and defaulted on follow-up. He represented with symptoms of acute spinal cord compression and magnetic resonance imaging demonstrated a lesion at T6/7. Neurosurgical resection of the lesion showed it to be a metastatic deposit from the ureteric primary. Despite surgical debulking and subsequent radiotherapy to the lesion, the patient died secondary to metastatic complications. This case report is of interest to the surgeon as it demonstrates both the high metastatic potential of upper tract carcinomas and educates the surgeon on the presentation of acute spinal cord compression.

Two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis in the lower extremities without clinical symptoms or signs in the upper extremities

Background context There is no report in the literature of two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis/paralysis exclusively in the bilateral lower extremities. Purpose To identify the clinical characteristics of specific myelopathy resulting from C6–C7 disc herniation through a case with spastic paresis in the lower extremities without upper extremities symptoms due to separate disc herniation in the cervical and thoracic spine, which was surgically removed in two stages. Study design/setting A case report. Methods A 48-year-old man developed a gait disturbance as well as weakness and numbness in the lower extremities. Thoracic magnetic resonance imaging (MRI) showed a T11–T12 disc herniation, which was removed under the surgical microscope through a minimally invasive posterior approach. He improved, but 2 months after surgery developed recurrent numbness and spasticity. On this occasion, no evidence of recurrence of the thoracic disc herniation could be identified, but cervical MRI demonstrated a compressed spinal cord at the C6–C7 level. The patient had no neurological findings in the upper extremities. The herniated disc at C6–C7 was removed under the surgical microscope with laminoplasty. Results The symptoms gradually improved after surgery. At the present time, 2 years and 9 months after the initial operation, the patient had a stable gait and was able to work. Conclusions Our experience suggests that in the diagnosis of patients with spastic paresis and sensory disturbances in the lower extremities, spinal cord compression should be explored by imaging studies not only in the thoracic spine but also in the cervical spine, especially at the C6–C7 level, even if the symptoms and abnormal neurological findings are absent in the upper extremities.

Primary amyloidoma of the thoracic spine presenting with acute paraplegia

BACKGROUNDPrimary solitary amyloidoma of the spine is a rare disease characterized by localized deposition of amyloid. To the best of our knowledge, there have been only 14 cases previously reported in the literature. Patients with focal spinal amyloidoma usually have relatively long symptomatic periods preoperatively, ranging from 3 weeks to 6 years (mean: 12 months). Only two reported patients had acute paraplegia. We add a third case of a thoracic spine amyloidoma presenting with acute paraplegia.CASE DESCRIPTIONA 65-year-old man presented with a three-day history of progressive paraplegia and urinary retention. He was found to have severe cord compression at T2 on magnetic resonance imaging. He underwent emergent decompressive laminectomy with instrumentation for spinal stabilization. Histopathology revealed abundant amyloid deposits. A systemic work-up was negative for amyloidosis. The patient showed marked neurological improvement with residual mild spastic gait after 1 year.CONCLUSIONSPrimary spinal amyloidoma with acute paraplegia is rare. One-stage surgery combining prompt decompression and stabilization of the spinal column is mandatory in cases of spinal amyloidoma with acute myelopathy, because primary solitary amyloidoma carries a good prognosis.

Tophaceous Gout of the Thoracic Spine Presenting as Back Pain and Fever

Spinal gout has been reported only rarely. We describe a 59-year-old man with a history of gout, who was receiving chronic immunosuppressive therapy after a renal transplant and who presented with fever and back pain. After an extensive work-up and biopsy, the diagnosis was thoracic tophaceous gout. The pain and fever responded to prednisone and allopurinol. Tophaceous gout is a rare cause of fever and back pain but should be considered in the differential diagnosis in the appropriate clinical setting.

Ganglioneuroma of the Thoracic Spine Presenting as Adolescent Idiopathic Scoliosis

Ganglioneuromas are rare soft-tissue tumors that can present as painless spinal deformities. The surgical outcome is usually satisfactory when complete excision is achieved. A case of spinal ganglioneuroma presenting as adolescent idiopathic scoliosis is presented to illustrate the illusive nature of this condition.